TropicalMed, Vol. 4, Pages 49: Assessing the Presence of Wuchereria bancrofti Infections in Vectors Using Xenomonitoring in Lymphatic Filariasis Endemic Districts in Ghanahttp://www.mdpi.com/2414-6366/4/1/49
Mass drug administration (MDA) is the current mainstay to interrupt the transmission of lymphatic filariasis. To monitor whether MDA is effective and transmission of lymphatic filariasis indeed has been interrupted, rigorous surveillance is required. Assessment of transmission by programme managers is usually done via serology. New research suggests that xenomonitoring holds promise for determining the success of lymphatic filariasis interventions. The objective of this study was to assess Wuchereria bancrofti infection in mosquitoes as a post-MDA surveillance tool using xenomonitoring. The study was carried out in four districts of Ghana; Ahanta West, Mpohor, Kassena Nankana West and Bongo. A suite of mosquito sampling methods was employed, including human landing collections, pyrethrum spray catches and window exit traps. Infection of W. bancrofti in mosquitoes was determined using dissection, conventional and real-time polymerase chain reaction and loop mediated isothermal amplification assays. Aedes, Anopheles coustani, An. gambiae, An. pharoensis, Culex and Mansonia mosquitoes were sampled in each of the four study districts. The dissected mosquitoes were positive for filarial infection using molecular assays. Dissected An. melas mosquitoes from Ahanta West district were the only species found positive for filarial parasites. We conclude that whilst samples extracted with Trizol reagent did not show any positives, molecular methods should still be considered for monitoring and surveillance of lymphatic filariasis transmission.TropicalMed, Vol. 4, Pages 49: Assessing the Presence of Wuchereria bancrofti Infections in Vectors Using Xenomonitoring in Lymphatic Filariasis Endemic Districts in Ghana

Mass drug administration (MDA) is the current mainstay to interrupt the transmission of lymphatic filariasis. To monitor whether MDA is effective and transmission of lymphatic filariasis indeed has been interrupted, rigorous surveillance is required. Assessment of transmission by programme managers is usually done via serology. New research suggests that xenomonitoring holds promise for determining the success of lymphatic filariasis interventions. The objective of this study was to assess Wuchereria bancrofti infection in mosquitoes as a post-MDA surveillance tool using xenomonitoring. The study was carried out in four districts of Ghana; Ahanta West, Mpohor, Kassena Nankana West and Bongo. A suite of mosquito sampling methods was employed, including human landing collections, pyrethrum spray catches and window exit traps. Infection of W. bancrofti in mosquitoes was determined using dissection, conventional and real-time polymerase chain reaction and loop mediated isothermal amplification assays. Aedes, Anopheles coustani, An. gambiae, An. pharoensis, Culex and Mansonia mosquitoes were sampled in each of the four study districts. The dissected mosquitoes were positive for filarial infection using molecular assays. Dissected An. melas mosquitoes from Ahanta West district were the only species found positive for filarial parasites. We conclude that whilst samples extracted with Trizol reagent did not show any positives, molecular methods should still be considered for monitoring and surveillance of lymphatic filariasis transmission.

]]>Assessing the Presence of Wuchereria bancrofti Infections in Vectors Using Xenomonitoring in Lymphatic Filariasis Endemic Districts in GhanaSellase Pi-BansaJoseph H. N. OseiWorlasi D. Kartey-AttipoeElizabeth ElhassanDavid AgyemangSampson OtooSamuel K. DadzieMaxwell A. AppawuMichael D. WilsonBenjamin G. KoudouDziedzom K. de SouzaJürg UtzingerDaniel A. Boakyedoi: 10.3390/tropicalmed4010049Tropical Medicine and Infectious Disease2019-03-17Tropical Medicine and Infectious Disease2019-03-1741Article4910.3390/tropicalmed4010049http://www.mdpi.com/2414-6366/4/1/49TropicalMed, Vol. 4, Pages 48: The Mite-Gallery Unit: A New Concept for Describing Scabies through Entodermoscopyhttp://www.mdpi.com/2414-6366/4/1/48
Scabies has always represented a diagnostic challenge for dermatologists, especially in subclinical cases or in atypical ones due to the coexistence of other diseases. Fortunately, dermatoscopy has enabled easier and faster in situ diagnosis. The aim of this study is to examine old and new dermatoscopic signs that Sarcoptes scabiei produces on the skin during its whole life cycle through entodermoscopy (dermatoscopy with an entomological focus) which, unlike traditional optical microscope examination, allows the local micro-environment to be preserved intact. Patients were enrolled during outbreaks of scabies from hospitals or nursing homes for the elderly in Bari (Italy). The study was performed applying both immersion and polarized dry dermatoscopy. The systematic use of dermatoscopy highlighted the morphological complexity of the Sarcoptes tunnel that had been described previously as a simple unitary structure. On the contrary, it is possible to distinguish three separate segments of the burrow that introduce a new anatomo-functional concept called the Mite-Gallery Unit (MGU). This approach, based on the mite life cycle and local skin turnover (the latter usually being ignored), allows the dermatologist to recognize not only Sarcoptes using the gallery, but also new descriptors including tunnels without Sarcoptes, those with acari alone, and those with associated signs of inflammation. The diagnosis of scabies using optical microscopy until recently has always involved demonstrating the mite and its products outside the human body (on a glass slide) without taking into account exactly what happens within the epidermis. Entodermoscopy is a term used to encapsulate both the presence of the parasite, the usual target of microscopy, and the changes produced in the superficial layers of the epidermis in situ. Thus, the scabies tunnel or burrow can be shown to be composed of three parts, the Head, Body, and Tail, in which different events affecting both mite and host develop. The Mite-Gallery Unit provides a new anatomical and functional explanation of scabies because it provides a more comprehensive in vivo and in situ dermatoscopic diagnosis. In this respect, dermatoscopy takes into account the behavior of the mite in addition to its interaction with its habitat, the human skin.TropicalMed, Vol. 4, Pages 48: The Mite-Gallery Unit: A New Concept for Describing Scabies through Entodermoscopy

Scabies has always represented a diagnostic challenge for dermatologists, especially in subclinical cases or in atypical ones due to the coexistence of other diseases. Fortunately, dermatoscopy has enabled easier and faster in situ diagnosis. The aim of this study is to examine old and new dermatoscopic signs that Sarcoptes scabiei produces on the skin during its whole life cycle through entodermoscopy (dermatoscopy with an entomological focus) which, unlike traditional optical microscope examination, allows the local micro-environment to be preserved intact. Patients were enrolled during outbreaks of scabies from hospitals or nursing homes for the elderly in Bari (Italy). The study was performed applying both immersion and polarized dry dermatoscopy. The systematic use of dermatoscopy highlighted the morphological complexity of the Sarcoptes tunnel that had been described previously as a simple unitary structure. On the contrary, it is possible to distinguish three separate segments of the burrow that introduce a new anatomo-functional concept called the Mite-Gallery Unit (MGU). This approach, based on the mite life cycle and local skin turnover (the latter usually being ignored), allows the dermatologist to recognize not only Sarcoptes using the gallery, but also new descriptors including tunnels without Sarcoptes, those with acari alone, and those with associated signs of inflammation. The diagnosis of scabies using optical microscopy until recently has always involved demonstrating the mite and its products outside the human body (on a glass slide) without taking into account exactly what happens within the epidermis. Entodermoscopy is a term used to encapsulate both the presence of the parasite, the usual target of microscopy, and the changes produced in the superficial layers of the epidermis in situ. Thus, the scabies tunnel or burrow can be shown to be composed of three parts, the Head, Body, and Tail, in which different events affecting both mite and host develop. The Mite-Gallery Unit provides a new anatomical and functional explanation of scabies because it provides a more comprehensive in vivo and in situ dermatoscopic diagnosis. In this respect, dermatoscopy takes into account the behavior of the mite in addition to its interaction with its habitat, the human skin.

]]>The Mite-Gallery Unit: A New Concept for Describing Scabies through EntodermoscopyGaetano Scannidoi: 10.3390/tropicalmed4010048Tropical Medicine and Infectious Disease2019-03-16Tropical Medicine and Infectious Disease2019-03-1641Article4810.3390/tropicalmed4010048http://www.mdpi.com/2414-6366/4/1/48TropicalMed, Vol. 4, Pages 47: How Can Operational Research Help to Eliminate Tuberculosis in the Asia Pacific Region?http://www.mdpi.com/2414-6366/4/1/47
Broad multi-sectoral action is required to end the tuberculosis (TB) epidemic by 2030 and this includes National TB Programmes (NTPs) fully delivering on quality-assured diagnostic, treatment and preventive services. Large implementation gaps currently exist in the delivery of these services, which can be addressed and closed through the discipline of operational research. This paper outlines the TB disease burden and disease-control programme implementation gaps in the Asia-Pacific region; discusses the key priority areas in diagnosis, treatment and prevention where operational research can be used to make a difference; and finally provides guidance about how best to embed operational research within a TB programme setting. Achieving internationally agreed milestones and targets for case finding and treatment requires the NTP to be streamlined and efficient in the delivery of its services, and operational research provides the necessary evidence-based knowledge and support to allow this to happen.TropicalMed, Vol. 4, Pages 47: How Can Operational Research Help to Eliminate Tuberculosis in the Asia Pacific Region?

Broad multi-sectoral action is required to end the tuberculosis (TB) epidemic by 2030 and this includes National TB Programmes (NTPs) fully delivering on quality-assured diagnostic, treatment and preventive services. Large implementation gaps currently exist in the delivery of these services, which can be addressed and closed through the discipline of operational research. This paper outlines the TB disease burden and disease-control programme implementation gaps in the Asia-Pacific region; discusses the key priority areas in diagnosis, treatment and prevention where operational research can be used to make a difference; and finally provides guidance about how best to embed operational research within a TB programme setting. Achieving internationally agreed milestones and targets for case finding and treatment requires the NTP to be streamlined and efficient in the delivery of its services, and operational research provides the necessary evidence-based knowledge and support to allow this to happen.

]]>How Can Operational Research Help to Eliminate Tuberculosis in the Asia Pacific Region?Anthony D. HarriesAjay M. V. KumarSrinath SatyanarayanaPruthu ThekkurYan LinRiitta A. DlodloRony Zachariahdoi: 10.3390/tropicalmed4010047Tropical Medicine and Infectious Disease2019-03-15Tropical Medicine and Infectious Disease2019-03-1541Perspective4710.3390/tropicalmed4010047http://www.mdpi.com/2414-6366/4/1/47TropicalMed, Vol. 4, Pages 46: Insights into Australian Bat Lyssavirus in Insectivorous Bats of Western Australiahttp://www.mdpi.com/2414-6366/4/1/46
Australian bat lyssavirus (ABLV) is a known causative agent of neurological disease in bats, humans and horses. It has been isolated from four species of pteropid bats and a single microbat species (Saccolaimus flaviventris). To date, ABLV surveillance has primarily been passive, with active surveillance concentrating on eastern and northern Australian bat populations. As a result, there is scant regional ABLV information for large areas of the country. To better inform the local public health risks associated with human-bat interactions, this study describes the lyssavirus prevalence in microbat communities in the South West Botanical Province of Western Australia. We used targeted real-time PCR assays to detect viral RNA shedding in 839 oral swabs representing 12 species of microbats, which were sampled over two consecutive summers spanning 2016&amp;ndash;2018. Additionally, we tested 649 serum samples via Luminex&amp;reg; assay for reactivity to lyssavirus antigens. Active lyssavirus infection was not detected in any of the samples. Lyssavirus antibodies were detected in 19 individuals across six species, with a crude prevalence of 2.9% (95% CI: 1.8&amp;ndash;4.5%) over the two years. In addition, we present the first records of lyssavirus exposure in two Nyctophilus species, and Falsistrellus mackenziei.TropicalMed, Vol. 4, Pages 46: Insights into Australian Bat Lyssavirus in Insectivorous Bats of Western Australia

Australian bat lyssavirus (ABLV) is a known causative agent of neurological disease in bats, humans and horses. It has been isolated from four species of pteropid bats and a single microbat species (Saccolaimus flaviventris). To date, ABLV surveillance has primarily been passive, with active surveillance concentrating on eastern and northern Australian bat populations. As a result, there is scant regional ABLV information for large areas of the country. To better inform the local public health risks associated with human-bat interactions, this study describes the lyssavirus prevalence in microbat communities in the South West Botanical Province of Western Australia. We used targeted real-time PCR assays to detect viral RNA shedding in 839 oral swabs representing 12 species of microbats, which were sampled over two consecutive summers spanning 2016&amp;ndash;2018. Additionally, we tested 649 serum samples via Luminex&amp;reg; assay for reactivity to lyssavirus antigens. Active lyssavirus infection was not detected in any of the samples. Lyssavirus antibodies were detected in 19 individuals across six species, with a crude prevalence of 2.9% (95% CI: 1.8&amp;ndash;4.5%) over the two years. In addition, we present the first records of lyssavirus exposure in two Nyctophilus species, and Falsistrellus mackenziei.

]]>Insights into Australian Bat Lyssavirus in Insectivorous Bats of Western AustraliaDiana PradaVictoria BoydMichelle BakerBethany JacksonMark O’Deadoi: 10.3390/tropicalmed4010046Tropical Medicine and Infectious Disease2019-03-11Tropical Medicine and Infectious Disease2019-03-1141Article4610.3390/tropicalmed4010046http://www.mdpi.com/2414-6366/4/1/46TropicalMed, Vol. 4, Pages 45: Investigation of Mixture Modelling Algorithms as a Tool for Determining the Statistical Likelihood of Serological Exposure to Filariasis Utilizing Historical Data from the Lymphatic Filariasis Surveillance Program in Vanuatuhttp://www.mdpi.com/2414-6366/4/1/45
As the prevalence of lymphatic filariasis declines, it becomes crucial to adequately eliminate residual areas of endemicity and implement surveillance. To this end, serological assays have been developed, including the Bm14 Filariasis CELISA which recommends a specific optical density cut-off level. We used mixture modelling to assess positive cut-offs of Bm14 serology in children in Vanuatu using historical OD (Optical Density) ELISA values collected from a transmission assessment survey (2005) and a targeted child survey (2008). Mixture modelling is a statistical technique using probability distributions to identify subpopulations of positive and negative results (absolute cut-off value) and an 80% indeterminate range around the absolute cut-off (80% cut-off). Depending on programmatic choices, utilizing the lower 80% cut-off ensures the inclusion of all likely positives, however with the trade-off of lower specificity. For 2005, country-wide antibody prevalence estimates varied from 6.4% (previous cut-off) through 9.0% (absolute cut-off) to 17.3% (lower 80% cut-off). This corroborated historical evidence of hotspots in Pentecost Island in Penama province. For 2008, there were no differences in the prevalence rates using any of the thresholds. In conclusion, mixture modelling is a powerful tool that allows closer monitoring of residual transmission spots and these findings supported additional monitoring which was conducted in Penama in later years. Utilizing a statistical data-based cut-off, as opposed to a universal cut-off, may help guide program decisions that are better suited to the national program.TropicalMed, Vol. 4, Pages 45: Investigation of Mixture Modelling Algorithms as a Tool for Determining the Statistical Likelihood of Serological Exposure to Filariasis Utilizing Historical Data from the Lymphatic Filariasis Surveillance Program in Vanuatu

As the prevalence of lymphatic filariasis declines, it becomes crucial to adequately eliminate residual areas of endemicity and implement surveillance. To this end, serological assays have been developed, including the Bm14 Filariasis CELISA which recommends a specific optical density cut-off level. We used mixture modelling to assess positive cut-offs of Bm14 serology in children in Vanuatu using historical OD (Optical Density) ELISA values collected from a transmission assessment survey (2005) and a targeted child survey (2008). Mixture modelling is a statistical technique using probability distributions to identify subpopulations of positive and negative results (absolute cut-off value) and an 80% indeterminate range around the absolute cut-off (80% cut-off). Depending on programmatic choices, utilizing the lower 80% cut-off ensures the inclusion of all likely positives, however with the trade-off of lower specificity. For 2005, country-wide antibody prevalence estimates varied from 6.4% (previous cut-off) through 9.0% (absolute cut-off) to 17.3% (lower 80% cut-off). This corroborated historical evidence of hotspots in Pentecost Island in Penama province. For 2008, there were no differences in the prevalence rates using any of the thresholds. In conclusion, mixture modelling is a powerful tool that allows closer monitoring of residual transmission spots and these findings supported additional monitoring which was conducted in Penama in later years. Utilizing a statistical data-based cut-off, as opposed to a universal cut-off, may help guide program decisions that are better suited to the national program.

]]>Investigation of Mixture Modelling Algorithms as a Tool for Determining the Statistical Likelihood of Serological Exposure to Filariasis Utilizing Historical Data from the Lymphatic Filariasis Surveillance Program in VanuatuHayley JosephSarah SullivanPeter WoodWayne MelroseFasihah TaleoPatricia Gravesdoi: 10.3390/tropicalmed4010045Tropical Medicine and Infectious Disease2019-03-08Tropical Medicine and Infectious Disease2019-03-0841Article4510.3390/tropicalmed4010045http://www.mdpi.com/2414-6366/4/1/45TropicalMed, Vol. 4, Pages 44: The Global Burden of Disease of Zoonotic Parasitic Diseases: Top 5 Contenders for Priority Considerationhttp://www.mdpi.com/2414-6366/4/1/44
With the rise of global migration, international trade, and global environmental challenges such as climate change, it is not surprising that the interactions between humans and other animals are shifting. Salient infectious diseases, such as malaria and HIV (which have high burdens of disease), attract sophisticated public health frameworks and funding from global/regional organisations, such as the WHO. This unfortunately detracts attention from the many emerging zoonoses that fall under the radar as neglected tropical diseases (NTDs). This review considers the available literature and the attribution of burden of disease to the most insidious NTDs and recommends which five are deserving of policy prioritisation. In line with WHO analyses of NTDs, intestinal nematode infections, leishmaniasis, schistosomiasis, and lymphatic filariasis should be prioritised, as well as the burden of disease of cryptosporidiosis, which is largely underestimated. Both monitoring and treatment/prevention control methods for cryptosporidiosis are suggested and explored.TropicalMed, Vol. 4, Pages 44: The Global Burden of Disease of Zoonotic Parasitic Diseases: Top 5 Contenders for Priority Consideration

With the rise of global migration, international trade, and global environmental challenges such as climate change, it is not surprising that the interactions between humans and other animals are shifting. Salient infectious diseases, such as malaria and HIV (which have high burdens of disease), attract sophisticated public health frameworks and funding from global/regional organisations, such as the WHO. This unfortunately detracts attention from the many emerging zoonoses that fall under the radar as neglected tropical diseases (NTDs). This review considers the available literature and the attribution of burden of disease to the most insidious NTDs and recommends which five are deserving of policy prioritisation. In line with WHO analyses of NTDs, intestinal nematode infections, leishmaniasis, schistosomiasis, and lymphatic filariasis should be prioritised, as well as the burden of disease of cryptosporidiosis, which is largely underestimated. Both monitoring and treatment/prevention control methods for cryptosporidiosis are suggested and explored.

]]>The Global Burden of Disease of Zoonotic Parasitic Diseases: Top 5 Contenders for Priority ConsiderationKonrad Pisarskidoi: 10.3390/tropicalmed4010044Tropical Medicine and Infectious Disease2019-03-02Tropical Medicine and Infectious Disease2019-03-0241Review4410.3390/tropicalmed4010044http://www.mdpi.com/2414-6366/4/1/44TropicalMed, Vol. 4, Pages 43: The First Outbreak of Dengue Fever in Greater Darfur, Western Sudanhttp://www.mdpi.com/2414-6366/4/1/43
Dengue virus (DENV) is an arthropod-borne virus (arbovirus) transmitted by the Aedes mosquitoes, mainly Aedes aegypti. Dengue fever is a rapidly growing disease with expanding geographical distribution worldwide. We investigated a high number of non-malaria febrile cases reported to health clinics in refugee camps in the five states of Darfur between August 2015 and March 2016. The clinical presentation of cases and case definition criteria suggested involvement of one or more arboviral hemorrhagic fevers. Out of 560 suspected cases, we collected and analyzed 204 blood samples and serologically positive samples were confirmed by PCR. We identified 32 (15.7%) dengue viral infections, six West Nile virus infections, and three Crimean&amp;ndash;Congo viral infections. Dengue infections were found in four out of the five Darfur states. We reported the first dengue fever outbreak in the Darfur region. Our results highlight the need for public health education and further molecular, phylogenetic, and entomological investigations for a better understanding of the disease transmission and the associated risk factors in the region.TropicalMed, Vol. 4, Pages 43: The First Outbreak of Dengue Fever in Greater Darfur, Western Sudan

Dengue virus (DENV) is an arthropod-borne virus (arbovirus) transmitted by the Aedes mosquitoes, mainly Aedes aegypti. Dengue fever is a rapidly growing disease with expanding geographical distribution worldwide. We investigated a high number of non-malaria febrile cases reported to health clinics in refugee camps in the five states of Darfur between August 2015 and March 2016. The clinical presentation of cases and case definition criteria suggested involvement of one or more arboviral hemorrhagic fevers. Out of 560 suspected cases, we collected and analyzed 204 blood samples and serologically positive samples were confirmed by PCR. We identified 32 (15.7%) dengue viral infections, six West Nile virus infections, and three Crimean&amp;ndash;Congo viral infections. Dengue infections were found in four out of the five Darfur states. We reported the first dengue fever outbreak in the Darfur region. Our results highlight the need for public health education and further molecular, phylogenetic, and entomological investigations for a better understanding of the disease transmission and the associated risk factors in the region.

]]>The First Outbreak of Dengue Fever in Greater Darfur, Western SudanAyman AhmedAdel EldumaBabiker MagboulTarig HigaziYousif Alidoi: 10.3390/tropicalmed4010043Tropical Medicine and Infectious Disease2019-03-01Tropical Medicine and Infectious Disease2019-03-0141Communication4310.3390/tropicalmed4010043http://www.mdpi.com/2414-6366/4/1/43TropicalMed, Vol. 4, Pages 42: A One Health Approach to Investigating Leptospira Serogroups and Their Spatial Distributions among Humans and Animals in Rio Grande do Sul, Brazil, 2013–2015http://www.mdpi.com/2414-6366/4/1/42
Leptospirosis is an endemic zoonotic disease in Brazil and is widespread throughout rural populations in the state of Rio Grande do Sul. This study aimed to identify presumptive infecting Leptospira serogroups in human and animal cases and describe their occurrences within the ecoregions of the state by animal species. Data for human and animal leptospirosis cases were gathered from the government&amp;rsquo;s passive surveillance systems and presumptive infecting serogroups were identified based on a two-fold titer difference in serogroups in the microscopic agglutination test (MAT) panel. A total of 22 different serogroups were reported across both human and animal cases. Serogroup Icterohaemorrhagiae was the most common among humans, while serogroup Sejroe predominated among animal cases, particularly bovines. Each ecoregion had a large distribution of cases, with 51% of the human cases in the Parana&amp;ndash;Paraiba ecoregion, and 81% of the animal cases in the Savannah ecoregion. Identifying and mapping the serogroups circulating using the One Health approach is the first step for further understanding the distribution of the disease in the state. This study has the potential to aid in guiding public health and agricultural practices, furthering the need for a human vaccine in high-risk populations to complement control and prevention efforts.TropicalMed, Vol. 4, Pages 42: A One Health Approach to Investigating Leptospira Serogroups and Their Spatial Distributions among Humans and Animals in Rio Grande do Sul, Brazil, 2013–2015

Leptospirosis is an endemic zoonotic disease in Brazil and is widespread throughout rural populations in the state of Rio Grande do Sul. This study aimed to identify presumptive infecting Leptospira serogroups in human and animal cases and describe their occurrences within the ecoregions of the state by animal species. Data for human and animal leptospirosis cases were gathered from the government&amp;rsquo;s passive surveillance systems and presumptive infecting serogroups were identified based on a two-fold titer difference in serogroups in the microscopic agglutination test (MAT) panel. A total of 22 different serogroups were reported across both human and animal cases. Serogroup Icterohaemorrhagiae was the most common among humans, while serogroup Sejroe predominated among animal cases, particularly bovines. Each ecoregion had a large distribution of cases, with 51% of the human cases in the Parana&amp;ndash;Paraiba ecoregion, and 81% of the animal cases in the Savannah ecoregion. Identifying and mapping the serogroups circulating using the One Health approach is the first step for further understanding the distribution of the disease in the state. This study has the potential to aid in guiding public health and agricultural practices, furthering the need for a human vaccine in high-risk populations to complement control and prevention efforts.

]]>A One Health Approach to Investigating Leptospira Serogroups and Their Spatial Distributions among Humans and Animals in Rio Grande do Sul, Brazil, 2013–2015Noemi PoloGustavo MachadoRogerio RodriguesPatricia Nájera HamrickClaudia Munoz-ZanziMartha Maria PereiraMarilina BerciniLoeci Natalina TimmMaria Cristina Schneiderdoi: 10.3390/tropicalmed4010042Tropical Medicine and Infectious Disease2019-02-27Tropical Medicine and Infectious Disease2019-02-2741Article4210.3390/tropicalmed4010042http://www.mdpi.com/2414-6366/4/1/42TropicalMed, Vol. 4, Pages 41: Sowing the Seeds of a Pandemic? Mammalian Pathogenicity and Transmissibility of H1 Variant Influenza Viruses from the Swine Reservoirhttp://www.mdpi.com/2414-6366/4/1/41
Emergence of genetically and antigenically diverse strains of influenza to which the human population has no or limited immunity necessitates continuous risk assessments to determine the likelihood of these viruses acquiring adaptations that facilitate sustained human-to-human transmission. As the North American swine H1 virus population has diversified over the last century by means of both antigenic drift and shift, in vivo assessments to study multifactorial traits like mammalian pathogenicity and transmissibility of these emerging influenza viruses are critical. In this review, we examine genetic, molecular, and pathogenicity and transmissibility data from a panel of contemporary North American H1 subtype swine-origin viruses isolated from humans, as compared to H1N1 seasonal and pandemic viruses, including the reconstructed 1918 virus. We present side-by-side analyses of experiments performed in the mouse and ferret models using consistent experimental protocols to facilitate enhanced interpretation of in vivo data. Contextualizing these analyses in a broader context permits a greater appreciation of the role that in vivo risk assessment experiments play in pandemic preparedness. Collectively, we find that despite strain-specific heterogeneity among swine-origin H1 viruses, contemporary swine viruses isolated from humans possess many attributes shared by prior pandemic strains, warranting heightened surveillance and evaluation of these zoonotic viruses.TropicalMed, Vol. 4, Pages 41: Sowing the Seeds of a Pandemic? Mammalian Pathogenicity and Transmissibility of H1 Variant Influenza Viruses from the Swine Reservoir

Emergence of genetically and antigenically diverse strains of influenza to which the human population has no or limited immunity necessitates continuous risk assessments to determine the likelihood of these viruses acquiring adaptations that facilitate sustained human-to-human transmission. As the North American swine H1 virus population has diversified over the last century by means of both antigenic drift and shift, in vivo assessments to study multifactorial traits like mammalian pathogenicity and transmissibility of these emerging influenza viruses are critical. In this review, we examine genetic, molecular, and pathogenicity and transmissibility data from a panel of contemporary North American H1 subtype swine-origin viruses isolated from humans, as compared to H1N1 seasonal and pandemic viruses, including the reconstructed 1918 virus. We present side-by-side analyses of experiments performed in the mouse and ferret models using consistent experimental protocols to facilitate enhanced interpretation of in vivo data. Contextualizing these analyses in a broader context permits a greater appreciation of the role that in vivo risk assessment experiments play in pandemic preparedness. Collectively, we find that despite strain-specific heterogeneity among swine-origin H1 viruses, contemporary swine viruses isolated from humans possess many attributes shared by prior pandemic strains, warranting heightened surveillance and evaluation of these zoonotic viruses.

]]>Sowing the Seeds of a Pandemic? Mammalian Pathogenicity and Transmissibility of H1 Variant Influenza Viruses from the Swine ReservoirJoanna A. Pulit-PenalozaJessica A. BelserTerrence M. TumpeyTaronna R. Mainesdoi: 10.3390/tropicalmed4010041Tropical Medicine and Infectious Disease2019-02-27Tropical Medicine and Infectious Disease2019-02-2741Review4110.3390/tropicalmed4010041http://www.mdpi.com/2414-6366/4/1/41TropicalMed, Vol. 4, Pages 40: Asian Schistosomiasis: Current Status and Prospects for Control Leading to Eliminationhttp://www.mdpi.com/2414-6366/4/1/40
Schistosomiasis is an infectious disease caused by helminth parasites of the genus Schistosoma. Worldwide, an estimated 250 million people are infected with these parasites with the majority of cases occurring in sub-Saharan Africa. Within Asia, three species of Schistosoma cause disease. Schistosoma japonicum is the most prevalent, followed by S. mekongi and S. malayensis. All three species are zoonotic, which causes concern for their control, as successful elimination not only requires management of the human definitive host, but also the animal reservoir hosts. With regard to Asian schistosomiasis, most of the published research has focused on S. japonicum with comparatively little attention paid to S. mekongi and even less focus on S. malayensis. In this review, we examine the three Asian schistosomes and their current status in their endemic countries: Cambodia, Lao People&amp;rsquo;s Democratic Republic, Myanmar, and Thailand (S. mekongi); Malaysia (S. malayensis); and Indonesia, People&amp;rsquo;s Republic of China, and the Philippines (S. japonicum). Prospects for control that could potentially lead to elimination are highlighted as these can inform researchers and disease control managers in other schistosomiasis-endemic areas, particularly in Africa and the Americas.TropicalMed, Vol. 4, Pages 40: Asian Schistosomiasis: Current Status and Prospects for Control Leading to Elimination

Schistosomiasis is an infectious disease caused by helminth parasites of the genus Schistosoma. Worldwide, an estimated 250 million people are infected with these parasites with the majority of cases occurring in sub-Saharan Africa. Within Asia, three species of Schistosoma cause disease. Schistosoma japonicum is the most prevalent, followed by S. mekongi and S. malayensis. All three species are zoonotic, which causes concern for their control, as successful elimination not only requires management of the human definitive host, but also the animal reservoir hosts. With regard to Asian schistosomiasis, most of the published research has focused on S. japonicum with comparatively little attention paid to S. mekongi and even less focus on S. malayensis. In this review, we examine the three Asian schistosomes and their current status in their endemic countries: Cambodia, Lao People&amp;rsquo;s Democratic Republic, Myanmar, and Thailand (S. mekongi); Malaysia (S. malayensis); and Indonesia, People&amp;rsquo;s Republic of China, and the Philippines (S. japonicum). Prospects for control that could potentially lead to elimination are highlighted as these can inform researchers and disease control managers in other schistosomiasis-endemic areas, particularly in Africa and the Americas.

]]>Asian Schistosomiasis: Current Status and Prospects for Control Leading to EliminationCatherine A. GordonJohanna KurscheidGail M. WilliamsArchie C. A. ClementsYuesheng LiXiao-Nong ZhouJürg UtzingerDonald P. McManusDarren J. Graydoi: 10.3390/tropicalmed4010040Tropical Medicine and Infectious Disease2019-02-26Tropical Medicine and Infectious Disease2019-02-2641Review4010.3390/tropicalmed4010040http://www.mdpi.com/2414-6366/4/1/40TropicalMed, Vol. 4, Pages 39: Endemic Melioidosis in Southern China: Past and Presenthttp://www.mdpi.com/2414-6366/4/1/39
Melioidosis is a severe tropical infectious disease caused by the soil-dwelling bacterium Burkholderia pseudomallei, predominantly endemic to Southeast Asia and northern Australia. Between the 1970s and the 1990s, the presence of B. pseudomallei causing melioidosis in humans and other animals was demonstrated in four coastal provinces in southern China: Hainan, Guangdong, Guangxi, and Fujian, although indigenous cases were rare and the disease failed to raise concern amongst local and national health authorities. In recent years, there has been a rise in the number of melioidosis cases witnessed in the region, particularly in Hainan. Meanwhile, although China has established and maintained an effective communicable disease surveillance system, it has not yet been utilized for melioidosis. Thus, the overall incidence, social burden and epidemiological features of the disease in China remain unclear. In this context, we present a comprehensive overview of both historical and current information on melioidosis in Southern China, highlighting the re-emergence of the disease in Hainan. Surveillance and management strategies for melioidosis should be promoted in mainland China, and more research should be conducted to provide further insights into the present situation.TropicalMed, Vol. 4, Pages 39: Endemic Melioidosis in Southern China: Past and Present

Melioidosis is a severe tropical infectious disease caused by the soil-dwelling bacterium Burkholderia pseudomallei, predominantly endemic to Southeast Asia and northern Australia. Between the 1970s and the 1990s, the presence of B. pseudomallei causing melioidosis in humans and other animals was demonstrated in four coastal provinces in southern China: Hainan, Guangdong, Guangxi, and Fujian, although indigenous cases were rare and the disease failed to raise concern amongst local and national health authorities. In recent years, there has been a rise in the number of melioidosis cases witnessed in the region, particularly in Hainan. Meanwhile, although China has established and maintained an effective communicable disease surveillance system, it has not yet been utilized for melioidosis. Thus, the overall incidence, social burden and epidemiological features of the disease in China remain unclear. In this context, we present a comprehensive overview of both historical and current information on melioidosis in Southern China, highlighting the re-emergence of the disease in Hainan. Surveillance and management strategies for melioidosis should be promoted in mainland China, and more research should be conducted to provide further insights into the present situation.

]]>Endemic Melioidosis in Southern China: Past and PresentXiao ZhengQianfeng XiaLianxu XiaWei Lidoi: 10.3390/tropicalmed4010039Tropical Medicine and Infectious Disease2019-02-25Tropical Medicine and Infectious Disease2019-02-2541Review3910.3390/tropicalmed4010039http://www.mdpi.com/2414-6366/4/1/39TropicalMed, Vol. 4, Pages 38: Japanese Encephalitis Virus in Australia: From Known Known to Known Unknownhttp://www.mdpi.com/2414-6366/4/1/38
Japanese encephalitis virus (JEV) is a major cause of neurological disease in Asia. It is a zoonotic flavivirus transmitted between water birds and/or pigs by Culex mosquitoes; humans are dead-end hosts. In 1995, JEV emerged for the first time in northern Australia causing an unprecedented outbreak in the Torres Strait. In this article, we revisit the history of JEV in Australia and describe investigations of JEV transmission cycles in the Australian context. Public health responses to the incipient outbreak included vaccination and sentinel pig surveillance programs. Virus isolation and vector competence experiments incriminated Culex annulirostris as the likely regional vector. The role this species plays in transmission cycles depends on the availability of domestic pigs as a blood source. Experimental evidence suggests that native animals are relatively poor amplifying hosts of JEV. The persistence and predominantly annual virus activity between 1995 and 2005 suggested that JEV had become endemic in the Torres Strait. However, active surveillance was discontinued at the end of 2005, so the status of JEV in northern Australia is unknown. Novel mosquito-based surveillance systems provide a means to investigate whether JEV still occurs in the Torres Strait or is no longer a risk to Australia.TropicalMed, Vol. 4, Pages 38: Japanese Encephalitis Virus in Australia: From Known Known to Known Unknown

Japanese encephalitis virus (JEV) is a major cause of neurological disease in Asia. It is a zoonotic flavivirus transmitted between water birds and/or pigs by Culex mosquitoes; humans are dead-end hosts. In 1995, JEV emerged for the first time in northern Australia causing an unprecedented outbreak in the Torres Strait. In this article, we revisit the history of JEV in Australia and describe investigations of JEV transmission cycles in the Australian context. Public health responses to the incipient outbreak included vaccination and sentinel pig surveillance programs. Virus isolation and vector competence experiments incriminated Culex annulirostris as the likely regional vector. The role this species plays in transmission cycles depends on the availability of domestic pigs as a blood source. Experimental evidence suggests that native animals are relatively poor amplifying hosts of JEV. The persistence and predominantly annual virus activity between 1995 and 2005 suggested that JEV had become endemic in the Torres Strait. However, active surveillance was discontinued at the end of 2005, so the status of JEV in northern Australia is unknown. Novel mosquito-based surveillance systems provide a means to investigate whether JEV still occurs in the Torres Strait or is no longer a risk to Australia.

]]>Japanese Encephalitis Virus in Australia: From Known Known to Known UnknownAndrew F. van den HurkAlyssa T. PykeJohn S. MackenzieSonja Hall-MendelinScott A. Ritchiedoi: 10.3390/tropicalmed4010038Tropical Medicine and Infectious Disease2019-02-20Tropical Medicine and Infectious Disease2019-02-2041Review3810.3390/tropicalmed4010038http://www.mdpi.com/2414-6366/4/1/38TropicalMed, Vol. 4, Pages 37: Comparison of Knowledge, Attitude, and Practice among Communities Living in Hotspot and Non-Hotspot Areas of Dengue in Selangor, Malaysiahttp://www.mdpi.com/2414-6366/4/1/37
Background: Dengue has affected more than one-third of the world population and Malaysia has recorded an increase in the number of dengue cases since 2012. Selangor state recorded the highest number of dengue cases in Malaysia. Most of the dengue infections occur among people living in hotspot areas of dengue. This study aims to compare Knowledge, Attitude, and Practice among communities living in hotspot and non-hotspot dengue areas. Method: Communities living in 20 hotspot and 20 non-hotspot areas in Selangor were chosen in this study where 406 participants were randomly selected to answer questionnaires distributed at their housing areas. Total marks of each categories were compared using t-test. Result: Results show that there were significant mean differences in marks in Knowledge (p value: 0.003; 15.41 vs. 14.55) and Attitude (p value: &amp;lt; 0.001; 11.41 vs. 10.33), but not Practice (p value 0.101; 10.83 vs. 10.47) categories between communities of non-hotspot and hotspot areas. After considering two confounding variables which are education level and household income, different mean marks are found to be significant in Knowledge when education level acts as a covariate and Attitude when both act as covariates. Conclusion: Overall results show that people living in non-hotspot areas had better knowledge and attitude than people living in hotspot areas, but no difference was found in practice. This suggests that public health education should be done more frequently with people with a low education background and low household income, especially in hotspot areas to fight dengue outbreak and make dengue cases decrease effectively.TropicalMed, Vol. 4, Pages 37: Comparison of Knowledge, Attitude, and Practice among Communities Living in Hotspot and Non-Hotspot Areas of Dengue in Selangor, Malaysia

Background: Dengue has affected more than one-third of the world population and Malaysia has recorded an increase in the number of dengue cases since 2012. Selangor state recorded the highest number of dengue cases in Malaysia. Most of the dengue infections occur among people living in hotspot areas of dengue. This study aims to compare Knowledge, Attitude, and Practice among communities living in hotspot and non-hotspot dengue areas. Method: Communities living in 20 hotspot and 20 non-hotspot areas in Selangor were chosen in this study where 406 participants were randomly selected to answer questionnaires distributed at their housing areas. Total marks of each categories were compared using t-test. Result: Results show that there were significant mean differences in marks in Knowledge (p value: 0.003; 15.41 vs. 14.55) and Attitude (p value: &amp;lt; 0.001; 11.41 vs. 10.33), but not Practice (p value 0.101; 10.83 vs. 10.47) categories between communities of non-hotspot and hotspot areas. After considering two confounding variables which are education level and household income, different mean marks are found to be significant in Knowledge when education level acts as a covariate and Attitude when both act as covariates. Conclusion: Overall results show that people living in non-hotspot areas had better knowledge and attitude than people living in hotspot areas, but no difference was found in practice. This suggests that public health education should be done more frequently with people with a low education background and low household income, especially in hotspot areas to fight dengue outbreak and make dengue cases decrease effectively.

]]>Comparison of Knowledge, Attitude, and Practice among Communities Living in Hotspot and Non-Hotspot Areas of Dengue in Selangor, MalaysiaNurul GhaniShamarina ShohaimiAlvin HeeHui-Yee CheeOguntade EmmanuelLamidi Alaba Ajiboladoi: 10.3390/tropicalmed4010037Tropical Medicine and Infectious Disease2019-02-15Tropical Medicine and Infectious Disease2019-02-1541Article3710.3390/tropicalmed4010037http://www.mdpi.com/2414-6366/4/1/37TropicalMed, Vol. 4, Pages 35: Hemoptysis in the Immunocompromised Patient: Do Not Forget Strongyloidiasishttp://www.mdpi.com/2414-6366/4/1/35
Strongyloidiasis, due to infection with the nematode Strongyloides stercoralis, affects millions of people in the tropics and subtropics. Strongyloides has a unique auto-infective lifecycle such that it can persist in the human host for decades. In immunosuppressed patients, especially those on corticosteroids, potentially fatal disseminated strongyloidiasis can occur, often with concurrent secondary infections. Herein, we present two immunocompromised patients with severe strongyloidiasis who presented with pneumonia, hemoptysis, and sepsis. Both patients were immigrants from developing countries and had received prolonged courses of corticosteroids prior to admission. Patient 1 also presented with a diffuse abdominal rash; a skin biopsy showed multiple intradermal Strongyloides larvae. Patient 1 had concurrent pneumonic nocardiosis and bacteremia with Klebsiella pneumoniae and Enterococcus faecalis. Patient 2 had concurrent Aspergillus and Candida pneumonia and developed an Aerococcus meningitis. Both patients had negative serologic tests for Strongyloides; patient 2 manifested intermittent eosinophilia. In both patients, the diagnosis was afforded by bronchoscopy with lavage. The patients were successfully treated with broad-spectrum antibiotics and ivermectin. Patient 1 also received albendazole. Strongyloidiasis should be considered in the differential diagnosis of hemoptysis in immunocompromised patients with possible prior exposure to S. stercoralis.TropicalMed, Vol. 4, Pages 35: Hemoptysis in the Immunocompromised Patient: Do Not Forget Strongyloidiasis

Strongyloidiasis, due to infection with the nematode Strongyloides stercoralis, affects millions of people in the tropics and subtropics. Strongyloides has a unique auto-infective lifecycle such that it can persist in the human host for decades. In immunosuppressed patients, especially those on corticosteroids, potentially fatal disseminated strongyloidiasis can occur, often with concurrent secondary infections. Herein, we present two immunocompromised patients with severe strongyloidiasis who presented with pneumonia, hemoptysis, and sepsis. Both patients were immigrants from developing countries and had received prolonged courses of corticosteroids prior to admission. Patient 1 also presented with a diffuse abdominal rash; a skin biopsy showed multiple intradermal Strongyloides larvae. Patient 1 had concurrent pneumonic nocardiosis and bacteremia with Klebsiella pneumoniae and Enterococcus faecalis. Patient 2 had concurrent Aspergillus and Candida pneumonia and developed an Aerococcus meningitis. Both patients had negative serologic tests for Strongyloides; patient 2 manifested intermittent eosinophilia. In both patients, the diagnosis was afforded by bronchoscopy with lavage. The patients were successfully treated with broad-spectrum antibiotics and ivermectin. Patient 1 also received albendazole. Strongyloidiasis should be considered in the differential diagnosis of hemoptysis in immunocompromised patients with possible prior exposure to S. stercoralis.

]]>Hemoptysis in the Immunocompromised Patient: Do Not Forget StrongyloidiasisPrakash ShresthaSean E. O’NeilBarbara S. TaylorOlaoluwa Bode-OmoleyeGregory M. Ansteaddoi: 10.3390/tropicalmed4010035Tropical Medicine and Infectious Disease2019-02-12Tropical Medicine and Infectious Disease2019-02-1241Case Report3510.3390/tropicalmed4010035http://www.mdpi.com/2414-6366/4/1/35TropicalMed, Vol. 4, Pages 36: Burden of Acute Respiratory Infections Among Under-Five Children in Relation to Household Wealth and Socioeconomic Status in Bangladeshhttp://www.mdpi.com/2414-6366/4/1/36
Acute respiratory infections (ARIs), as a group of diseases and symptoms, are a leading cause of morbidity and mortality among under-five children in tropical countries like Bangladesh. Currently, no clear evidence has been published on the prevalence and socioeconomic correlates of ARIs in Bangladesh. In this regard, we carried out this study with the aim of assessing the prevalence and the socioeconomic predictors of ARIs among children aged 0&amp;ndash;59 months, with a special focus on socioeconomic status and wealth-related indicators. Cross-sectional data on 32,998 mother-child (singleton) pairs were collected from six rounds of Bangladesh Demographic and Health Surveys (BDHS 1997&amp;ndash;2014). The outcome variable were presence of the common symptoms of ARIs, fever and dyspnea, during the previous two weeks, which were measured based on mothers&amp;rsquo; reports about the symptoms of these conditions. Explanatory variables included maternal demographic and socioeconomic factors such as age, education, occupation, wealth quintile, and child&amp;rsquo;s age and sex. The prevalence and predictors of ARIs were measured using descriptive and multivariate regression methods. The prevalence of both fever (31.00% in 1997 vs. 36.76% in 2014) and dyspnea (39.27% in 1997 vs. 43.27% in 2014) has increased gradually since 1997, and tended to be higher in households in the lower wealth quintiles. Multivariable analysis revealed that higher maternal educational status, access to improved water and sanitation facilities, and living in households in higher wealth quintiles had protective effects against both fever and dyspnea. Findings suggested a significantly negative association between lacking access to improved water and sanitation and use of biomass fuel with ARI symptoms. However, no sex difference was observed in these associations. Based on the findings, childhood ARI prevention strategies should address the risk factors stemming from parental socioeconomic marginalisation, household water and sanitation poverty, and use of unclean fuel.TropicalMed, Vol. 4, Pages 36: Burden of Acute Respiratory Infections Among Under-Five Children in Relation to Household Wealth and Socioeconomic Status in Bangladesh

Acute respiratory infections (ARIs), as a group of diseases and symptoms, are a leading cause of morbidity and mortality among under-five children in tropical countries like Bangladesh. Currently, no clear evidence has been published on the prevalence and socioeconomic correlates of ARIs in Bangladesh. In this regard, we carried out this study with the aim of assessing the prevalence and the socioeconomic predictors of ARIs among children aged 0&amp;ndash;59 months, with a special focus on socioeconomic status and wealth-related indicators. Cross-sectional data on 32,998 mother-child (singleton) pairs were collected from six rounds of Bangladesh Demographic and Health Surveys (BDHS 1997&amp;ndash;2014). The outcome variable were presence of the common symptoms of ARIs, fever and dyspnea, during the previous two weeks, which were measured based on mothers&amp;rsquo; reports about the symptoms of these conditions. Explanatory variables included maternal demographic and socioeconomic factors such as age, education, occupation, wealth quintile, and child&amp;rsquo;s age and sex. The prevalence and predictors of ARIs were measured using descriptive and multivariate regression methods. The prevalence of both fever (31.00% in 1997 vs. 36.76% in 2014) and dyspnea (39.27% in 1997 vs. 43.27% in 2014) has increased gradually since 1997, and tended to be higher in households in the lower wealth quintiles. Multivariable analysis revealed that higher maternal educational status, access to improved water and sanitation facilities, and living in households in higher wealth quintiles had protective effects against both fever and dyspnea. Findings suggested a significantly negative association between lacking access to improved water and sanitation and use of biomass fuel with ARI symptoms. However, no sex difference was observed in these associations. Based on the findings, childhood ARI prevention strategies should address the risk factors stemming from parental socioeconomic marginalisation, household water and sanitation poverty, and use of unclean fuel.

]]>Burden of Acute Respiratory Infections Among Under-Five Children in Relation to Household Wealth and Socioeconomic Status in BangladeshSanni YayaGhose Bishwajitdoi: 10.3390/tropicalmed4010036Tropical Medicine and Infectious Disease2019-02-12Tropical Medicine and Infectious Disease2019-02-1241Article3610.3390/tropicalmed4010036http://www.mdpi.com/2414-6366/4/1/36TropicalMed, Vol. 4, Pages 34: Potential Intermediate Hosts for Coronavirus Transmission: No Evidence of Clade 2c Coronaviruses in Domestic Livestock from Ghanahttp://www.mdpi.com/2414-6366/4/1/34
The emergence of Middle East Respiratory Syndrome Coronavirus (MERS-CoV), nearly a decade ago with worldwide distribution, was believed to be of zoonotic origin from bats with dromedary camels as intermediate hosts. There is a likelihood of other domestic livestock serving as intermediate hosts for this virus. The presence of coronaviruses, closely related to MERS-CoV in Ghanaian bats, presented the opportunity to test the hypothesis of transmissibility of this virus through domestic livestock species. The possible interactions between livestock and bats in 31 household farms were accessed by observation and interviews with farmers. Rectal swabs and serum from cattle, sheep, goats, donkeys, and swine from commercial and household farms were tested for MERS-CoV and a Nycteris sp. bat coronavirus, previously detected in Ghana. A pan-PCR assay to detect clade 2c viruses and recombinant immunofluorescence assay to detect anti-spike IgG antibodies against the target viruses were used. Likely contact between livestock and bats was determined for 13 farms (41.9%) that reported confining their livestock and also observing bats in their homes. Livestock were left unconfined on eight farms (25.8%) that also observed bats roosting in trees close to their homes. No viral RNA or antibodies against the two coronaviruses were detected in any of the livestock species tested. Cattle, sheep, goats, donkeys, and swine are not likely hosts of clade 2c coronaviruses.TropicalMed, Vol. 4, Pages 34: Potential Intermediate Hosts for Coronavirus Transmission: No Evidence of Clade 2c Coronaviruses in Domestic Livestock from Ghana

The emergence of Middle East Respiratory Syndrome Coronavirus (MERS-CoV), nearly a decade ago with worldwide distribution, was believed to be of zoonotic origin from bats with dromedary camels as intermediate hosts. There is a likelihood of other domestic livestock serving as intermediate hosts for this virus. The presence of coronaviruses, closely related to MERS-CoV in Ghanaian bats, presented the opportunity to test the hypothesis of transmissibility of this virus through domestic livestock species. The possible interactions between livestock and bats in 31 household farms were accessed by observation and interviews with farmers. Rectal swabs and serum from cattle, sheep, goats, donkeys, and swine from commercial and household farms were tested for MERS-CoV and a Nycteris sp. bat coronavirus, previously detected in Ghana. A pan-PCR assay to detect clade 2c viruses and recombinant immunofluorescence assay to detect anti-spike IgG antibodies against the target viruses were used. Likely contact between livestock and bats was determined for 13 farms (41.9%) that reported confining their livestock and also observing bats in their homes. Livestock were left unconfined on eight farms (25.8%) that also observed bats roosting in trees close to their homes. No viral RNA or antibodies against the two coronaviruses were detected in any of the livestock species tested. Cattle, sheep, goats, donkeys, and swine are not likely hosts of clade 2c coronaviruses.

]]>Potential Intermediate Hosts for Coronavirus Transmission: No Evidence of Clade 2c Coronaviruses in Domestic Livestock from GhanaPhilip El-DuahAugustina SylverkenMichael OwusuRichmond YeboahJones LampteyYaw Oppong FrimpongVitus BurimuahChristopher AntwiRaphael FolitseOlivia AgbenyegaSamuel OppongYaw Adu-Sarkodiedoi: 10.3390/tropicalmed4010034Tropical Medicine and Infectious Disease2019-02-10Tropical Medicine and Infectious Disease2019-02-1041Article3410.3390/tropicalmed4010034http://www.mdpi.com/2414-6366/4/1/34TropicalMed, Vol. 4, Pages 33: Molecular Evidence of Drug-Resistant Tuberculosis in the Balimo Region of Papua New Guineahttp://www.mdpi.com/2414-6366/4/1/33
Papua New Guinea (PNG) has a high burden of tuberculosis (TB), including drug-resistant TB (DR-TB). DR-TB has been identified in patients in Western Province, although there has been limited study outside the provincial capital of Daru. This study focuses on the Balimo region of Western Province, aiming to identify the proportion of DR-TB, and characterise Mycobacterium tuberculosis (MTB) drug resistance-associated gene mutations. Sputum samples were investigated for MTB infection using published molecular methods. DNA from MTB-positive samples was amplified and sequenced, targeting the rpoB and katG genes to identify mutations associated with rifampicin and isoniazid resistance respectively. A total of 240 sputum samples were collected at Balimo District Hospital (BDH). Of these, 86 were classified as positive based on the results of the molecular assays. For samples where rpoB sequencing was successful, 10.0% (5/50, 95% CI 4.4&amp;ndash;21.4%) were considered rifampicin-resistant through detection of drug resistance-associated mutations. We have identified high rates of presumptive DR-TB in the Balimo region of Western Province, PNG. These results emphasise the importance of further surveillance, and strengthening of diagnostic and treatment services at BDH and throughout Western Province, to facilitate detection and treatment of DR-TB, and limit transmission in this setting.TropicalMed, Vol. 4, Pages 33: Molecular Evidence of Drug-Resistant Tuberculosis in the Balimo Region of Papua New Guinea

Papua New Guinea (PNG) has a high burden of tuberculosis (TB), including drug-resistant TB (DR-TB). DR-TB has been identified in patients in Western Province, although there has been limited study outside the provincial capital of Daru. This study focuses on the Balimo region of Western Province, aiming to identify the proportion of DR-TB, and characterise Mycobacterium tuberculosis (MTB) drug resistance-associated gene mutations. Sputum samples were investigated for MTB infection using published molecular methods. DNA from MTB-positive samples was amplified and sequenced, targeting the rpoB and katG genes to identify mutations associated with rifampicin and isoniazid resistance respectively. A total of 240 sputum samples were collected at Balimo District Hospital (BDH). Of these, 86 were classified as positive based on the results of the molecular assays. For samples where rpoB sequencing was successful, 10.0% (5/50, 95% CI 4.4&amp;ndash;21.4%) were considered rifampicin-resistant through detection of drug resistance-associated mutations. We have identified high rates of presumptive DR-TB in the Balimo region of Western Province, PNG. These results emphasise the importance of further surveillance, and strengthening of diagnostic and treatment services at BDH and throughout Western Province, to facilitate detection and treatment of DR-TB, and limit transmission in this setting.

]]>Molecular Evidence of Drug-Resistant Tuberculosis in the Balimo Region of Papua New GuineaTanya Diefenbach-ElstobVanina GuernierGraham BurgessDaniel PelowaRobert DowiBisato GulaMunish PuriWilliam PomatEmma McBrydeDavid PlummerCatherine RushJeffrey Warnerdoi: 10.3390/tropicalmed4010033Tropical Medicine and Infectious Disease2019-02-10Tropical Medicine and Infectious Disease2019-02-1041Article3310.3390/tropicalmed4010033http://www.mdpi.com/2414-6366/4/1/33TropicalMed, Vol. 4, Pages 32: Prevalence and Associated Factors of Taking Intermittent Preventive Treatment in Pregnancy in Sierra Leonehttp://www.mdpi.com/2414-6366/4/1/32
Malaria infection during pregnancy is a major public health problem in sub-Saharan Africa. The World Health Organization (WHO) recommends that gestational and congenital malaria can be prevented by using intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). IPTp-SP is a full therapeutic course of antimalarial medicine administered during pregnancy as a component of antenatal care. This study&amp;rsquo;s objective was to assess the prevalence and predictors of IPTp-SP uptake in pregnancy in Sierra Leone. This study was based on the fifth round of the Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2016. Participants were 8526 women aged between 15&amp;ndash;49 years. Outcome variables were uptake of IPTp-SP during the last pregnancy. Data were analysed using cross-tabulation and logistic regression methods. Results showed that the prevalence of taking IPTp-SP was 94.81% (92.40, 96.14), and that the prevalence of taking at least three doses was 93.24% (92.50, 94.81). In the multivariate logistic regression, education, parity, and antenatal care (ANC) use were significant predictors of IPTp-SP uptake. Women with higher education had lower odds of taking IPTp-SP (Odds Ratio = 0.647, 95%CI = 0.444, 0.943); having higher parity (&amp;gt;4) was associated with lower odds of taking IPTp-SP (OR = 0.663; 95%CI = 0.442, 0.994) and adequate ANC use increased the odds of taking IPTp-SP in both urban (OR = 1.450, 95%CI = 1.158, 3.128) and rural areas (OR = 1.903, 95%CI = 1.069, 1.966). In contrast, the positive association between ANC visits and adequate doses of taking IPTp-SP was true for rural women only (OR = 1.408, 95%CI = 1.174, 1.689). In conclusion, the use of IPTp-SP is close to being universal, with the prevalence being relatively higher in the rural areas. Based on our findings, promoting adequate antenatal care visits should be regarded as a key strategy to improve the use of IPTp-SP in Sierra Leone. Further studies could focus on exploring other predictors of IPTp-SP uptake that are not captured by MICS in Sierra Leone.TropicalMed, Vol. 4, Pages 32: Prevalence and Associated Factors of Taking Intermittent Preventive Treatment in Pregnancy in Sierra Leone

Malaria infection during pregnancy is a major public health problem in sub-Saharan Africa. The World Health Organization (WHO) recommends that gestational and congenital malaria can be prevented by using intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). IPTp-SP is a full therapeutic course of antimalarial medicine administered during pregnancy as a component of antenatal care. This study&amp;rsquo;s objective was to assess the prevalence and predictors of IPTp-SP uptake in pregnancy in Sierra Leone. This study was based on the fifth round of the Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2016. Participants were 8526 women aged between 15&amp;ndash;49 years. Outcome variables were uptake of IPTp-SP during the last pregnancy. Data were analysed using cross-tabulation and logistic regression methods. Results showed that the prevalence of taking IPTp-SP was 94.81% (92.40, 96.14), and that the prevalence of taking at least three doses was 93.24% (92.50, 94.81). In the multivariate logistic regression, education, parity, and antenatal care (ANC) use were significant predictors of IPTp-SP uptake. Women with higher education had lower odds of taking IPTp-SP (Odds Ratio = 0.647, 95%CI = 0.444, 0.943); having higher parity (&amp;gt;4) was associated with lower odds of taking IPTp-SP (OR = 0.663; 95%CI = 0.442, 0.994) and adequate ANC use increased the odds of taking IPTp-SP in both urban (OR = 1.450, 95%CI = 1.158, 3.128) and rural areas (OR = 1.903, 95%CI = 1.069, 1.966). In contrast, the positive association between ANC visits and adequate doses of taking IPTp-SP was true for rural women only (OR = 1.408, 95%CI = 1.174, 1.689). In conclusion, the use of IPTp-SP is close to being universal, with the prevalence being relatively higher in the rural areas. Based on our findings, promoting adequate antenatal care visits should be regarded as a key strategy to improve the use of IPTp-SP in Sierra Leone. Further studies could focus on exploring other predictors of IPTp-SP uptake that are not captured by MICS in Sierra Leone.

]]>Prevalence and Associated Factors of Taking Intermittent Preventive Treatment in Pregnancy in Sierra LeoneAmos BuhKomlan KotaGhose BishwajitSanni Yayadoi: 10.3390/tropicalmed4010032Tropical Medicine and Infectious Disease2019-02-07Tropical Medicine and Infectious Disease2019-02-0741Article3210.3390/tropicalmed4010032http://www.mdpi.com/2414-6366/4/1/32TropicalMed, Vol. 4, Pages 31: Bats and Viruses: Emergence of Novel Lyssaviruses and Association of Bats with Viral Zoonoses in the EUhttp://www.mdpi.com/2414-6366/4/1/31
Bats in the EU have been associated with several zoonotic viral pathogens of significance to both human and animal health. Virus discovery continues to expand the existing understating of virus classification, and the increased interest in bats globally as reservoirs or carriers of zoonotic agents has fuelled the continued detection and characterisation of new lyssaviruses and other viral zoonoses. Although the transmission of lyssaviruses from bat species to humans or terrestrial species appears rare, interest in these viruses remains, through their ability to cause the invariably fatal encephalitis&amp;mdash;rabies. The association of bats with other viral zoonoses is also of great interest. Much of the EU is free of terrestrial rabies, but several bat species harbor lyssaviruses that remain a risk to human and animal health. Whilst the rabies virus is the main cause of rabies globally, novel related viruses continue to be discovered, predominantly in bat populations, that are of interest purely through their classification within the lyssavirus genus alongside the rabies virus. Although the rabies virus is principally transmitted from the bite of infected dogs, these related lyssaviruses are primarily transmitted to humans and terrestrial carnivores by bats. Even though reports of zoonotic viruses from bats within the EU are rare, to protect human and animal health, it is important characterise novel bat viruses for several reasons, namely: (i) to investigate the mechanisms for the maintenance, potential routes of transmission, and resulting clinical signs, if any, in their natural hosts; (ii) to investigate the ability of existing vaccines, where available, to protect against these viruses; (iii) to evaluate the potential for spill over and onward transmission of viral pathogens in novel terrestrial hosts. This review is an update on the current situation regarding zoonotic virus discovery within bats in the EU, and provides details of potential future mechanisms to control the threat from these deadly pathogens.TropicalMed, Vol. 4, Pages 31: Bats and Viruses: Emergence of Novel Lyssaviruses and Association of Bats with Viral Zoonoses in the EU

Bats in the EU have been associated with several zoonotic viral pathogens of significance to both human and animal health. Virus discovery continues to expand the existing understating of virus classification, and the increased interest in bats globally as reservoirs or carriers of zoonotic agents has fuelled the continued detection and characterisation of new lyssaviruses and other viral zoonoses. Although the transmission of lyssaviruses from bat species to humans or terrestrial species appears rare, interest in these viruses remains, through their ability to cause the invariably fatal encephalitis&amp;mdash;rabies. The association of bats with other viral zoonoses is also of great interest. Much of the EU is free of terrestrial rabies, but several bat species harbor lyssaviruses that remain a risk to human and animal health. Whilst the rabies virus is the main cause of rabies globally, novel related viruses continue to be discovered, predominantly in bat populations, that are of interest purely through their classification within the lyssavirus genus alongside the rabies virus. Although the rabies virus is principally transmitted from the bite of infected dogs, these related lyssaviruses are primarily transmitted to humans and terrestrial carnivores by bats. Even though reports of zoonotic viruses from bats within the EU are rare, to protect human and animal health, it is important characterise novel bat viruses for several reasons, namely: (i) to investigate the mechanisms for the maintenance, potential routes of transmission, and resulting clinical signs, if any, in their natural hosts; (ii) to investigate the ability of existing vaccines, where available, to protect against these viruses; (iii) to evaluate the potential for spill over and onward transmission of viral pathogens in novel terrestrial hosts. This review is an update on the current situation regarding zoonotic virus discovery within bats in the EU, and provides details of potential future mechanisms to control the threat from these deadly pathogens.

]]>Bats and Viruses: Emergence of Novel Lyssaviruses and Association of Bats with Viral Zoonoses in the EURebecca ShipleyEdward WrightDavid SeldenGuanghui WuJames AegerterAnthony R FooksAshley C Banyarddoi: 10.3390/tropicalmed4010031Tropical Medicine and Infectious Disease2019-02-07Tropical Medicine and Infectious Disease2019-02-0741Review3110.3390/tropicalmed4010031http://www.mdpi.com/2414-6366/4/1/31TropicalMed, Vol. 4, Pages 30: Elimination of Schistosomiasis Mekongi from Endemic Areas in Cambodia and the Lao People’s Democratic Republic: Current Status and Planshttp://www.mdpi.com/2414-6366/4/1/30
The areas endemic for schistosomiasis in the Lao People&amp;rsquo;s Democratic Republic and in Cambodia were first reported 50 and 60 years ago, respectively. However, the causative parasite Schistosoma mekongi was not recognized as a separate species until 1978. The infection is distributed along a limited part of the Mekong River, regulated by the focal distribution of the intermediate snail host Neotricula aperta. Although more sensitive diagnostics imply a higher figure, the current use of stool examinations suggests that only about 1500 people are presently infected. This well-characterized setting should offer an exemplary potential for the elimination of the disease from its endemic areas; yet, the local topography, reservoir animals, and a dearth of safe water sources make transmission control a challenge. Control activities based on mass drug administration resulted in strong advances, and prevalence was reduced to less than 5% according to stool microscopy. Even so, transmission continues unabated, and the true number of infected people could be as much as 10 times higher than reported. On-going control activities are discussed together with plans for the future.TropicalMed, Vol. 4, Pages 30: Elimination of Schistosomiasis Mekongi from Endemic Areas in Cambodia and the Lao People’s Democratic Republic: Current Status and Plans

The areas endemic for schistosomiasis in the Lao People&amp;rsquo;s Democratic Republic and in Cambodia were first reported 50 and 60 years ago, respectively. However, the causative parasite Schistosoma mekongi was not recognized as a separate species until 1978. The infection is distributed along a limited part of the Mekong River, regulated by the focal distribution of the intermediate snail host Neotricula aperta. Although more sensitive diagnostics imply a higher figure, the current use of stool examinations suggests that only about 1500 people are presently infected. This well-characterized setting should offer an exemplary potential for the elimination of the disease from its endemic areas; yet, the local topography, reservoir animals, and a dearth of safe water sources make transmission control a challenge. Control activities based on mass drug administration resulted in strong advances, and prevalence was reduced to less than 5% according to stool microscopy. Even so, transmission continues unabated, and the true number of infected people could be as much as 10 times higher than reported. On-going control activities are discussed together with plans for the future.

]]>Elimination of Schistosomiasis Mekongi from Endemic Areas in Cambodia and the Lao People’s Democratic Republic: Current Status and PlansVirak KhieuSomphou SayasoneSinuon MuthMasashi KirinokiSakhone LaymanivongHiroshi OhmaeRekol HuyThipphavanh ChanthapaseuthAya YajimaRattanaxay PhetsouvanhRobert BergquistPeter Odermattdoi: 10.3390/tropicalmed4010030Tropical Medicine and Infectious Disease2019-02-07Tropical Medicine and Infectious Disease2019-02-0741Review3010.3390/tropicalmed4010030http://www.mdpi.com/2414-6366/4/1/30TropicalMed, Vol. 4, Pages 29: The Importance of Wildlife Disease Monitoring as Part of Global Surveillance for Zoonotic Diseases: The Role of Australiahttp://www.mdpi.com/2414-6366/4/1/29
Australia has a comprehensive system of capabilities and functions to prepare, detect and respond to health security threats. Strong cooperative links and coordination mechanisms exist between the human (public health) and animal arms of the health system in Australia. Wildlife is included in this system. Recent reviews of both the animal and human health sectors have highlighted Australia&amp;rsquo;s relative strengths in the detection and management of emerging zoonotic diseases. However, the risks to Australia posed by diseases with wildlife as part of their epidemiology will almost certainly become greater with changing land use and climate change and as societal attitudes bring wildlife, livestock and people into closer contact. These risks are not isolated to Australia but are global. A greater emphasis on wildlife disease surveillance to assist in the detection of emerging infectious diseases and integration of wildlife health into One Health policy will be critical in better preparing Australia and other countries in their efforts to recognize and manage the adverse impacts of zoonotic diseases on human health. Animal and human health practitioners are encouraged to consider wildlife in their day to day activities and to learn more about Australia&amp;rsquo;s system and how they can become more involved by visiting www.wildlifeheathaustralia.com.au.TropicalMed, Vol. 4, Pages 29: The Importance of Wildlife Disease Monitoring as Part of Global Surveillance for Zoonotic Diseases: The Role of Australia

Australia has a comprehensive system of capabilities and functions to prepare, detect and respond to health security threats. Strong cooperative links and coordination mechanisms exist between the human (public health) and animal arms of the health system in Australia. Wildlife is included in this system. Recent reviews of both the animal and human health sectors have highlighted Australia&amp;rsquo;s relative strengths in the detection and management of emerging zoonotic diseases. However, the risks to Australia posed by diseases with wildlife as part of their epidemiology will almost certainly become greater with changing land use and climate change and as societal attitudes bring wildlife, livestock and people into closer contact. These risks are not isolated to Australia but are global. A greater emphasis on wildlife disease surveillance to assist in the detection of emerging infectious diseases and integration of wildlife health into One Health policy will be critical in better preparing Australia and other countries in their efforts to recognize and manage the adverse impacts of zoonotic diseases on human health. Animal and human health practitioners are encouraged to consider wildlife in their day to day activities and to learn more about Australia&amp;rsquo;s system and how they can become more involved by visiting www.wildlifeheathaustralia.com.au.

]]>The Importance of Wildlife Disease Monitoring as Part of Global Surveillance for Zoonotic Diseases: The Role of AustraliaRupert WoodsAndrea ReissKeren Cox-WittonTiggy GrilloAndrew Petersdoi: 10.3390/tropicalmed4010029Tropical Medicine and Infectious Disease2019-02-06Tropical Medicine and Infectious Disease2019-02-0641Opinion2910.3390/tropicalmed4010029http://www.mdpi.com/2414-6366/4/1/29TropicalMed, Vol. 4, Pages 28: Realizing the World Health Organization’s End TB Strategy (2016–2035): How Can Social Approaches to Tuberculosis Elimination Contribute to Progress in Asia and the Pacific?http://www.mdpi.com/2414-6366/4/1/28
This review article discusses how social approaches to tuberculosis elimination might contribute to realizing the targets stipulated in the World Health Organization&amp;rsquo;s (WHO) End TB Strategy (2016&amp;ndash;2035), with an emphasis on opportunities for progress in Asia and the Pacific. Many factors known to advance tuberculosis transmission and progression are pervasive in Asia and the Pacific, such as worsening drug resistance, unregulated private sector development, and high population density. This review article argues that historically successful social solutions must be revisited and improved upon if current worldwide tuberculosis rates are to be sustainably reduced in the long term. For the ambitious targets laid down in the WHO&amp;rsquo;s End TB Strategy to be met, biomedical innovations such as point-of-care diagnostics and new treatments for multidrug-resistant tuberculosis (MDR-TB) must be implemented alongside economic, social, and environmental interventions. Implementing social, environmental, and economic interventions alongside biomedical innovations and universal healthcare coverage will, however, only be possible if the health and other government sectors, civil society, and at-risk populations unite to work collaboratively in coming years.TropicalMed, Vol. 4, Pages 28: Realizing the World Health Organization’s End TB Strategy (2016–2035): How Can Social Approaches to Tuberculosis Elimination Contribute to Progress in Asia and the Pacific?

This review article discusses how social approaches to tuberculosis elimination might contribute to realizing the targets stipulated in the World Health Organization&amp;rsquo;s (WHO) End TB Strategy (2016&amp;ndash;2035), with an emphasis on opportunities for progress in Asia and the Pacific. Many factors known to advance tuberculosis transmission and progression are pervasive in Asia and the Pacific, such as worsening drug resistance, unregulated private sector development, and high population density. This review article argues that historically successful social solutions must be revisited and improved upon if current worldwide tuberculosis rates are to be sustainably reduced in the long term. For the ambitious targets laid down in the WHO&amp;rsquo;s End TB Strategy to be met, biomedical innovations such as point-of-care diagnostics and new treatments for multidrug-resistant tuberculosis (MDR-TB) must be implemented alongside economic, social, and environmental interventions. Implementing social, environmental, and economic interventions alongside biomedical innovations and universal healthcare coverage will, however, only be possible if the health and other government sectors, civil society, and at-risk populations unite to work collaboratively in coming years.

]]>Realizing the World Health Organization’s End TB Strategy (2016–2035): How Can Social Approaches to Tuberculosis Elimination Contribute to Progress in Asia and the Pacific?Christopher A. Johndoi: 10.3390/tropicalmed4010028Tropical Medicine and Infectious Disease2019-02-05Tropical Medicine and Infectious Disease2019-02-0541Review2810.3390/tropicalmed4010028http://www.mdpi.com/2414-6366/4/1/28TropicalMed, Vol. 4, Pages 27: Epidemiology, Risk Factors and Seasonal Variation of Scrub Typhus Fever in Central Nepalhttp://www.mdpi.com/2414-6366/4/1/27
Scrub typhus is a mite-borne acute febrile illness caused by Orientia. tsutsugamushi, a zoonotic bacterial infection common in the region known as the tsutsugamushi triangle. This study aims to determine the seroprevalence, seasonal variation, and risk factors of scrub typhus among the acute febrile illness patients attending different hospitals of central Nepal. Blood samples were collected from hospitalized patients of acute febrile illness suspected of scrub typhus infection attending different hospitals of central Nepal from April 2017 to March 2018. The IgM antibody to Orientia tsutsugamushi was detected by using the Scrub Typhus Detect&amp;trade; Kit. Among the total cases (1585), 358 (22.58%) were positive for IgM Antibodies. Multivariate analysis identified several risks factors to be significantly associated with the scrub typhus infection, including gender (female) (odds ratio [OR] = 1.976, p &amp;le; 0.001, confidence interval [CI] = 1.417&amp;ndash;2.756), rural residential location (odds ratio [OR] = 0.431, p = 0.001, confidence interval [CI] = 0.260&amp;ndash;0.715), house near grassland (odds ratio [OR] = 3.288, p &amp;le; 0.001, confidence interval [CI] = 1.935&amp;ndash;5.587), and working in the field (odds ratio [OR] = 9.764, p = 0.004, confidence interval [CI] = 2.059&amp;ndash;46.315). The study findings indicate scrub typhus infection to be a significant health problem in Nepal. The proper diagnosis of infection cases, timely institution of therapy, public awareness, and vector control are important measures to be taken for the prevention and management of scrub typhus.TropicalMed, Vol. 4, Pages 27: Epidemiology, Risk Factors and Seasonal Variation of Scrub Typhus Fever in Central Nepal

Scrub typhus is a mite-borne acute febrile illness caused by Orientia. tsutsugamushi, a zoonotic bacterial infection common in the region known as the tsutsugamushi triangle. This study aims to determine the seroprevalence, seasonal variation, and risk factors of scrub typhus among the acute febrile illness patients attending different hospitals of central Nepal. Blood samples were collected from hospitalized patients of acute febrile illness suspected of scrub typhus infection attending different hospitals of central Nepal from April 2017 to March 2018. The IgM antibody to Orientia tsutsugamushi was detected by using the Scrub Typhus Detect&amp;trade; Kit. Among the total cases (1585), 358 (22.58%) were positive for IgM Antibodies. Multivariate analysis identified several risks factors to be significantly associated with the scrub typhus infection, including gender (female) (odds ratio [OR] = 1.976, p &amp;le; 0.001, confidence interval [CI] = 1.417&amp;ndash;2.756), rural residential location (odds ratio [OR] = 0.431, p = 0.001, confidence interval [CI] = 0.260&amp;ndash;0.715), house near grassland (odds ratio [OR] = 3.288, p &amp;le; 0.001, confidence interval [CI] = 1.935&amp;ndash;5.587), and working in the field (odds ratio [OR] = 9.764, p = 0.004, confidence interval [CI] = 2.059&amp;ndash;46.315). The study findings indicate scrub typhus infection to be a significant health problem in Nepal. The proper diagnosis of infection cases, timely institution of therapy, public awareness, and vector control are important measures to be taken for the prevention and management of scrub typhus.

]]>Epidemiology, Risk Factors and Seasonal Variation of Scrub Typhus Fever in Central NepalRajendra GautamKeshab ParajuliJeevan Bahadur Sherchanddoi: 10.3390/tropicalmed4010027Tropical Medicine and Infectious Disease2019-02-02Tropical Medicine and Infectious Disease2019-02-0241Article2710.3390/tropicalmed4010027http://www.mdpi.com/2414-6366/4/1/27TropicalMed, Vol. 4, Pages 26: Resistance to Artemisinin Combination Therapies (ACTs): Do Not Forget the Partner Drug!http://www.mdpi.com/2414-6366/4/1/26
Artemisinin-based combination therapies (ACTs) have become the mainstay for malaria treatment in almost all malaria endemic settings. Artemisinin derivatives are highly potent and fast acting antimalarials; but they have a short half-life and need to be combined with partner drugs with a longer half-life to clear the remaining parasites after a standard 3-day ACT regimen. When introduced, ACTs were highly efficacious and contributed to the steep decrease of malaria over the last decades. However, parasites with decreased susceptibility to artemisinins have emerged in the Greater Mekong Subregion (GMS), followed by ACTs&amp;rsquo; failure, due to both decreased susceptibility to artemisinin and partner drug resistance. Therefore, there is an urgent need to strengthen and expand current resistance surveillance systems beyond the GMS to track the emergence or spread of artemisinin resistance. Great attention has been paid to the spread of artemisinin resistance over the last five years, since molecular markers of decreased susceptibility to artemisinin in the GMS have been discovered. However, resistance to partner drugs is critical, as ACTs can still be effective against parasites with decreased susceptibility to artemisinins, when the latter are combined with a highly efficacious partner drug. This review outlines the different mechanisms of resistance and molecular markers associated with resistance to partner drugs for the currently used ACTs. Strategies to improve surveillance and potential solutions to extend the useful therapeutic lifespan of the currently available malaria medicines are proposed.TropicalMed, Vol. 4, Pages 26: Resistance to Artemisinin Combination Therapies (ACTs): Do Not Forget the Partner Drug!

Artemisinin-based combination therapies (ACTs) have become the mainstay for malaria treatment in almost all malaria endemic settings. Artemisinin derivatives are highly potent and fast acting antimalarials; but they have a short half-life and need to be combined with partner drugs with a longer half-life to clear the remaining parasites after a standard 3-day ACT regimen. When introduced, ACTs were highly efficacious and contributed to the steep decrease of malaria over the last decades. However, parasites with decreased susceptibility to artemisinins have emerged in the Greater Mekong Subregion (GMS), followed by ACTs&amp;rsquo; failure, due to both decreased susceptibility to artemisinin and partner drug resistance. Therefore, there is an urgent need to strengthen and expand current resistance surveillance systems beyond the GMS to track the emergence or spread of artemisinin resistance. Great attention has been paid to the spread of artemisinin resistance over the last five years, since molecular markers of decreased susceptibility to artemisinin in the GMS have been discovered. However, resistance to partner drugs is critical, as ACTs can still be effective against parasites with decreased susceptibility to artemisinins, when the latter are combined with a highly efficacious partner drug. This review outlines the different mechanisms of resistance and molecular markers associated with resistance to partner drugs for the currently used ACTs. Strategies to improve surveillance and potential solutions to extend the useful therapeutic lifespan of the currently available malaria medicines are proposed.

]]>Resistance to Artemisinin Combination Therapies (ACTs): Do Not Forget the Partner Drug!Christian Nsanzabanadoi: 10.3390/tropicalmed4010026Tropical Medicine and Infectious Disease2019-02-01Tropical Medicine and Infectious Disease2019-02-0141Review2610.3390/tropicalmed4010026http://www.mdpi.com/2414-6366/4/1/26TropicalMed, Vol. 4, Pages 25: Acute Pulmonary Histoplasmosis Outbreak in A Documentary Film Crew Travelling from Guatemala to Australiahttp://www.mdpi.com/2414-6366/4/1/25
Histoplasma capsulatum is an endemic mycosis with a widespread distribution, although it is infrequently reported in travellers. In April 2018, five television crew members developed an acute febrile illness after filming a documentary about vampire bats in Guatemala. Patients developed symptoms after travelling to Australia, where they presented for medical care.TropicalMed, Vol. 4, Pages 25: Acute Pulmonary Histoplasmosis Outbreak in A Documentary Film Crew Travelling from Guatemala to Australia

Histoplasma capsulatum is an endemic mycosis with a widespread distribution, although it is infrequently reported in travellers. In April 2018, five television crew members developed an acute febrile illness after filming a documentary about vampire bats in Guatemala. Patients developed symptoms after travelling to Australia, where they presented for medical care.

]]>Acute Pulmonary Histoplasmosis Outbreak in A Documentary Film Crew Travelling from Guatemala to AustraliaStephen MuhiAmy CroweJohn Daffydoi: 10.3390/tropicalmed4010025Tropical Medicine and Infectious Disease2019-02-01Tropical Medicine and Infectious Disease2019-02-0141Case Report2510.3390/tropicalmed4010025http://www.mdpi.com/2414-6366/4/1/25TropicalMed, Vol. 4, Pages 24: Status of Schistosomiasis Elimination in the Caribbean Regionhttp://www.mdpi.com/2414-6366/4/1/24
Schistosomiasis elimination status in the Caribbean is reviewed with information on historical disease background, attempts to control it and current situation for each locality in the region where transmission has been eliminated (Sint Maarten, Saint Kitts, Vieques), eliminated but not yet verified (Puerto Rico, Dominican Republic, Antigua, Montserrat, Guadeloupe, Martinique) and still ongoing (Saint Lucia, Suriname). Integrated control initiatives based on selective and mass treatment and snail control using environmental, chemical and biological methods along with public service improvements (housing, safe water, sanitation) and changes in demography (urbanization) and economy (change from sugarcane and banana production to tourism) have resulted in reduction in the burden of schistosomiasis over the past century. Introduction of Biomphalaria-competitor snails into the region as a cost-effective, low maintenance control method appears to have had the most sustainable impact on transmission reduction. A regional inventory of B. glabrata, other Biomphalaria species and Biomphalaria-competitor snails as well as investigation of possible animal reservoir hosts in persisting endemic areas would be helpful for control. Elimination of schistosomiasis appears achievable in the Caribbean. However, a regional surveillance and monitoring program is needed to verify elimination in the various localities and identify and monitor areas still endemic or at risk.TropicalMed, Vol. 4, Pages 24: Status of Schistosomiasis Elimination in the Caribbean Region

Schistosomiasis elimination status in the Caribbean is reviewed with information on historical disease background, attempts to control it and current situation for each locality in the region where transmission has been eliminated (Sint Maarten, Saint Kitts, Vieques), eliminated but not yet verified (Puerto Rico, Dominican Republic, Antigua, Montserrat, Guadeloupe, Martinique) and still ongoing (Saint Lucia, Suriname). Integrated control initiatives based on selective and mass treatment and snail control using environmental, chemical and biological methods along with public service improvements (housing, safe water, sanitation) and changes in demography (urbanization) and economy (change from sugarcane and banana production to tourism) have resulted in reduction in the burden of schistosomiasis over the past century. Introduction of Biomphalaria-competitor snails into the region as a cost-effective, low maintenance control method appears to have had the most sustainable impact on transmission reduction. A regional inventory of B. glabrata, other Biomphalaria species and Biomphalaria-competitor snails as well as investigation of possible animal reservoir hosts in persisting endemic areas would be helpful for control. Elimination of schistosomiasis appears achievable in the Caribbean. However, a regional surveillance and monitoring program is needed to verify elimination in the various localities and identify and monitor areas still endemic or at risk.

]]>Status of Schistosomiasis Elimination in the Caribbean RegionReynold HewittArve Lee Willinghamdoi: 10.3390/tropicalmed4010024Tropical Medicine and Infectious Disease2019-01-31Tropical Medicine and Infectious Disease2019-01-3141Review2410.3390/tropicalmed4010024http://www.mdpi.com/2414-6366/4/1/24TropicalMed, Vol. 4, Pages 23: Diagnosis of Murine Typhus by Serology in Peninsular Malaysia: A Case Report Where Rickettsial Illnesses, Leptospirosis and Dengue Co-Circulatehttp://www.mdpi.com/2414-6366/4/1/23
Murine typhus is a rarely diagnosed cause of acute febrile illness in Malaysia, and its true disease burden is unknown. We report a case of an acute murine typhus infection in a patient living in a small city in Peninsular Malaysia, presenting with fever, rash, and headache. Unresponsive to the initial empirical treatment for leptospirosis, he showed a rapid response to doxycycline when murine typhus was diagnosed later. This case highlights the importance of considering murine typhus as a diagnostic in cases of acute febrile illness in urban and sub-urban areas, such as that of in Peninsular Malaysia.TropicalMed, Vol. 4, Pages 23: Diagnosis of Murine Typhus by Serology in Peninsular Malaysia: A Case Report Where Rickettsial Illnesses, Leptospirosis and Dengue Co-Circulate

Murine typhus is a rarely diagnosed cause of acute febrile illness in Malaysia, and its true disease burden is unknown. We report a case of an acute murine typhus infection in a patient living in a small city in Peninsular Malaysia, presenting with fever, rash, and headache. Unresponsive to the initial empirical treatment for leptospirosis, he showed a rapid response to doxycycline when murine typhus was diagnosed later. This case highlights the importance of considering murine typhus as a diagnostic in cases of acute febrile illness in urban and sub-urban areas, such as that of in Peninsular Malaysia.

]]>Diagnosis of Murine Typhus by Serology in Peninsular Malaysia: A Case Report Where Rickettsial Illnesses, Leptospirosis and Dengue Co-CirculateYazli YuhanaAmpai TanganuchitcharnchaiPimpan SujariyakulPiengchan SonthayanonKesinee ChotivanichDaniel H. ParisSasithon PukrittayakameeStuart D. BlacksellBorimas Hanboonkunupakarndoi: 10.3390/tropicalmed4010023Tropical Medicine and Infectious Disease2019-01-31Tropical Medicine and Infectious Disease2019-01-3141Case Report2310.3390/tropicalmed4010023http://www.mdpi.com/2414-6366/4/1/23TropicalMed, Vol. 4, Pages 22: One Health—Its Importance in Helping to Better Control Antimicrobial Resistancehttp://www.mdpi.com/2414-6366/4/1/22
Approaching any issue from a One Health perspective necessitates looking at the interactions of people, domestic animals, wildlife, plants, and our environment. For antimicrobial resistance this includes antimicrobial use (and abuse) in the human, animal and environmental sectors. More importantly, the spread of resistant bacteria and resistance determinants within and between these sectors and globally must be addressed. Better managing this problem includes taking steps to preserve the continued effectiveness of existing antimicrobials such as trying to eliminate their inappropriate use, particularly where they are used in high volumes. Examples are the mass medication of animals with critically important antimicrobials for humans, such as third generation cephalosporins and fluoroquinolones, and the long term, in-feed use of antimicrobials, such colistin, tetracyclines and macrolides, for growth promotion. In people it is essential to better prevent infections, reduce over-prescribing and over-use of antimicrobials and stop resistant bacteria from spreading by improving hygiene and infection control, drinking water and sanitation. Pollution from inadequate treatment of industrial, residential and farm waste is expanding the resistome in the environment. Numerous countries and several international agencies have now included a One Health Approach within their action plans to address antimicrobial resistance. Necessary actions include improvements in antimicrobial use, better regulation and policy, as well as improved surveillance, stewardship, infection control, sanitation, animal husbandry, and finding alternatives to antimicrobials.TropicalMed, Vol. 4, Pages 22: One Health—Its Importance in Helping to Better Control Antimicrobial Resistance

Approaching any issue from a One Health perspective necessitates looking at the interactions of people, domestic animals, wildlife, plants, and our environment. For antimicrobial resistance this includes antimicrobial use (and abuse) in the human, animal and environmental sectors. More importantly, the spread of resistant bacteria and resistance determinants within and between these sectors and globally must be addressed. Better managing this problem includes taking steps to preserve the continued effectiveness of existing antimicrobials such as trying to eliminate their inappropriate use, particularly where they are used in high volumes. Examples are the mass medication of animals with critically important antimicrobials for humans, such as third generation cephalosporins and fluoroquinolones, and the long term, in-feed use of antimicrobials, such colistin, tetracyclines and macrolides, for growth promotion. In people it is essential to better prevent infections, reduce over-prescribing and over-use of antimicrobials and stop resistant bacteria from spreading by improving hygiene and infection control, drinking water and sanitation. Pollution from inadequate treatment of industrial, residential and farm waste is expanding the resistome in the environment. Numerous countries and several international agencies have now included a One Health Approach within their action plans to address antimicrobial resistance. Necessary actions include improvements in antimicrobial use, better regulation and policy, as well as improved surveillance, stewardship, infection control, sanitation, animal husbandry, and finding alternatives to antimicrobials.

]]>One Health—Its Importance in Helping to Better Control Antimicrobial ResistancePeter J. CollignonScott A. McEwendoi: 10.3390/tropicalmed4010022Tropical Medicine and Infectious Disease2019-01-29Tropical Medicine and Infectious Disease2019-01-2941Review2210.3390/tropicalmed4010022http://www.mdpi.com/2414-6366/4/1/22TropicalMed, Vol. 4, Pages 21: A Call for Systems Epidemiology to Tackle the Complexity of Schistosomiasis, Its Control, and Its Eliminationhttp://www.mdpi.com/2414-6366/4/1/21
Ever since the first known written report of schistosomiasis in the mid-19th century, researchers have aimed to increase knowledge of the parasites, their hosts, and the mechanisms contributing to infection and disease. This knowledge generation has been paramount for the development of improved intervention strategies. Yet, despite a broad knowledge base of direct risk factors for schistosomiasis, there remains a paucity of information related to more complex, interconnected, and often hidden drivers of transmission that hamper intervention successes and sustainability. Such complex, multidirectional, non-linear, and synergistic interdependencies are best understood by looking at the integrated system as a whole. A research approach able to address this complexity and find previously neglected causal mechanisms for transmission, which include a wide variety of influencing factors, is needed. Systems epidemiology, as a holistic research approach, can integrate knowledge from classical epidemiology, with that of biology, ecology, social sciences, and other disciplines, and link this with informal, tacit knowledge from experts and affected populations. It can help to uncover wider-reaching but difficult-to-identify processes that directly or indirectly influence exposure, infection, transmission, and disease development, as well as how these interrelate and impact one another. Drawing on systems epidemiology to address persisting disease hotspots, failed intervention programmes, and systematically neglected population groups in mass drug administration programmes and research studies, can help overcome barriers in the progress towards schistosomiasis elimination. Generating a comprehensive view of the schistosomiasis system as a whole should thus be a priority research agenda towards the strategic goal of morbidity control and transmission elimination.TropicalMed, Vol. 4, Pages 21: A Call for Systems Epidemiology to Tackle the Complexity of Schistosomiasis, Its Control, and Its Elimination

Ever since the first known written report of schistosomiasis in the mid-19th century, researchers have aimed to increase knowledge of the parasites, their hosts, and the mechanisms contributing to infection and disease. This knowledge generation has been paramount for the development of improved intervention strategies. Yet, despite a broad knowledge base of direct risk factors for schistosomiasis, there remains a paucity of information related to more complex, interconnected, and often hidden drivers of transmission that hamper intervention successes and sustainability. Such complex, multidirectional, non-linear, and synergistic interdependencies are best understood by looking at the integrated system as a whole. A research approach able to address this complexity and find previously neglected causal mechanisms for transmission, which include a wide variety of influencing factors, is needed. Systems epidemiology, as a holistic research approach, can integrate knowledge from classical epidemiology, with that of biology, ecology, social sciences, and other disciplines, and link this with informal, tacit knowledge from experts and affected populations. It can help to uncover wider-reaching but difficult-to-identify processes that directly or indirectly influence exposure, infection, transmission, and disease development, as well as how these interrelate and impact one another. Drawing on systems epidemiology to address persisting disease hotspots, failed intervention programmes, and systematically neglected population groups in mass drug administration programmes and research studies, can help overcome barriers in the progress towards schistosomiasis elimination. Generating a comprehensive view of the schistosomiasis system as a whole should thus be a priority research agenda towards the strategic goal of morbidity control and transmission elimination.

]]>A Call for Systems Epidemiology to Tackle the Complexity of Schistosomiasis, Its Control, and Its EliminationStefanie J. KrauthJulie BalenGeoffrey N. GobertPoppy H. L. Lambertondoi: 10.3390/tropicalmed4010021Tropical Medicine and Infectious Disease2019-01-29Tropical Medicine and Infectious Disease2019-01-2941Concept Paper2110.3390/tropicalmed4010021http://www.mdpi.com/2414-6366/4/1/21TropicalMed, Vol. 4, Pages 20: Persistent Burkholderia pseudomallei Bacteremia in A Filipino Immigrant to the United States: A Case Reporthttp://www.mdpi.com/2414-6366/4/1/20
Melioidosis is rare in the United States and endemic to Southeast Asia and Australia. Treatment includes an initial intensive phase of intravenous ceftazidime or meropenem monotherapy depending on severity. The following report describes a case of persistent bacteremia with ceftazidime failure and prolonged meropenem therapy on a ceftazidime-susceptible strain of Burkholderia pseudomallei.TropicalMed, Vol. 4, Pages 20: Persistent Burkholderia pseudomallei Bacteremia in A Filipino Immigrant to the United States: A Case Report

Melioidosis is rare in the United States and endemic to Southeast Asia and Australia. Treatment includes an initial intensive phase of intravenous ceftazidime or meropenem monotherapy depending on severity. The following report describes a case of persistent bacteremia with ceftazidime failure and prolonged meropenem therapy on a ceftazidime-susceptible strain of Burkholderia pseudomallei.

]]>Persistent Burkholderia pseudomallei Bacteremia in A Filipino Immigrant to the United States: A Case ReportSumbul MerajBrandy RodenbergStephanie ThannumJared SheleyJena Foremandoi: 10.3390/tropicalmed4010020Tropical Medicine and Infectious Disease2019-01-28Tropical Medicine and Infectious Disease2019-01-2841Case Report2010.3390/tropicalmed4010020http://www.mdpi.com/2414-6366/4/1/20TropicalMed, Vol. 4, Pages 19: Tropical Medicine and Infectious Disease John M Goldsmid Award 2018http://www.mdpi.com/2414-6366/4/1/19
For many years, The Australasian College of Tropical Medicine (ACTM) has awarded the John M Goldsmid Award for the best paper published in its official journal, the Annals of the ACTM, in the previous year [...]TropicalMed, Vol. 4, Pages 19: Tropical Medicine and Infectious Disease John M Goldsmid Award 2018

For many years, The Australasian College of Tropical Medicine (ACTM) has awarded the John M Goldsmid Award for the best paper published in its official journal, the Annals of the ACTM, in the previous year [...]

]]>Tropical Medicine and Infectious Disease John M Goldsmid Award 2018 TropicalMed Editorial Officedoi: 10.3390/tropicalmed4010019Tropical Medicine and Infectious Disease2019-01-26Tropical Medicine and Infectious Disease2019-01-2641Editorial1910.3390/tropicalmed4010019http://www.mdpi.com/2414-6366/4/1/19TropicalMed, Vol. 4, Pages 18: A Short Report on the Lack of a Pyrogenic Response of Australian Genomic Group IV Isolates of Coxiella burnetii in Guinea Pigshttp://www.mdpi.com/2414-6366/4/1/18
This small study reports on a non-pyrogenic response of five different Australian isolates of Coxiella burnetii (C. burnetii). They were all members of Genomic Group IV and obtained from three cases of acute human infection, one case of chronic human infection and one case of goat abortion. The guinea pigs infected with these isolates did not develop fever (temperature &amp;ge; 40.0 &amp;deg;C), which is consistent with other members of this genomic group that were isolated from elsewhere in the world. In contrast, guinea pigs infected with the classical USA tick isolate, Nine Mile phase 1 (RSA 493) of Genomic Group I, experienced a four-day febrile period.TropicalMed, Vol. 4, Pages 18: A Short Report on the Lack of a Pyrogenic Response of Australian Genomic Group IV Isolates of Coxiella burnetii in Guinea Pigs

This small study reports on a non-pyrogenic response of five different Australian isolates of Coxiella burnetii (C. burnetii). They were all members of Genomic Group IV and obtained from three cases of acute human infection, one case of chronic human infection and one case of goat abortion. The guinea pigs infected with these isolates did not develop fever (temperature &amp;ge; 40.0 &amp;deg;C), which is consistent with other members of this genomic group that were isolated from elsewhere in the world. In contrast, guinea pigs infected with the classical USA tick isolate, Nine Mile phase 1 (RSA 493) of Genomic Group I, experienced a four-day febrile period.

]]>A Short Report on the Lack of a Pyrogenic Response of Australian Genomic Group IV Isolates of Coxiella burnetii in Guinea PigsAminul IslamJohn StenosGemma VincentStephen Gravesdoi: 10.3390/tropicalmed4010018Tropical Medicine and Infectious Disease2019-01-25Tropical Medicine and Infectious Disease2019-01-2541Brief Report1810.3390/tropicalmed4010018http://www.mdpi.com/2414-6366/4/1/18TropicalMed, Vol. 4, Pages 17: Escherichia hermannii Infections in Humans: A Systematic Reviewhttp://www.mdpi.com/2414-6366/4/1/17
Eshcerichia hermannii is a member of the Enterobacteriaceae, first described in 1982 and reclassified as a distinct species in the Escherichia genus after identifying biochemical and genomic differences from E. coli. It is a rare cause of human infections and is supposed to be a co-infector rather than an autonomous cause of infection. The aim of this systematic review was to record and evaluate all available evidence regarding human infections by E. hermannii. A systematic review of PubMed (through 21 December 2018) for studies providing epidemiological, clinical, and microbiological information, as well as treatment data and outcomes of E. hermannii infections was performed. A total of 16 studies, containing data of 17 patients, were eventually included in the analysis. The most common E. hermannii infections were bacteremias, urinary tract, and central nervous system infections. The complication rate, like the occurrence of sepsis, was high. Cephalosporins and aminoglycosides were the most common agents used for treatment. This systematic review describes bacterial infections by E. hermannii and provides information on the epidemiology, clinical presentation, antibiotic resistance, treatment, and outcomes associated with these infections.TropicalMed, Vol. 4, Pages 17: Escherichia hermannii Infections in Humans: A Systematic Review

Eshcerichia hermannii is a member of the Enterobacteriaceae, first described in 1982 and reclassified as a distinct species in the Escherichia genus after identifying biochemical and genomic differences from E. coli. It is a rare cause of human infections and is supposed to be a co-infector rather than an autonomous cause of infection. The aim of this systematic review was to record and evaluate all available evidence regarding human infections by E. hermannii. A systematic review of PubMed (through 21 December 2018) for studies providing epidemiological, clinical, and microbiological information, as well as treatment data and outcomes of E. hermannii infections was performed. A total of 16 studies, containing data of 17 patients, were eventually included in the analysis. The most common E. hermannii infections were bacteremias, urinary tract, and central nervous system infections. The complication rate, like the occurrence of sepsis, was high. Cephalosporins and aminoglycosides were the most common agents used for treatment. This systematic review describes bacterial infections by E. hermannii and provides information on the epidemiology, clinical presentation, antibiotic resistance, treatment, and outcomes associated with these infections.

]]>Correction: Tendler, M., et al. Current Status of the Sm14/GLA-SE Schistosomiasis Vaccine: Overcoming Barriers and Paradigms towards the First Anti-Parasitic Human(itarian) Vaccine. Trop. Med. Infect. Dis. 2018, 3, 121Miriam TendlerMarília S. AlmeidaMonica M. VilarPatrícia M. PintoGabriel Limaverde-Sousadoi: 10.3390/tropicalmed4010016Tropical Medicine and Infectious Disease2019-01-19Tropical Medicine and Infectious Disease2019-01-1941Correction1610.3390/tropicalmed4010016http://www.mdpi.com/2414-6366/4/1/16TropicalMed, Vol. 4, Pages 15: Use of Geospatial Surveillance and Response Systems for Vector-Borne Diseases in the Elimination Phasehttp://www.mdpi.com/2414-6366/4/1/15
The distribution of diseases caused by vector-borne viruses and parasites are restricted by the environmental requirements of their vectors, but also by the ambient temperature inside the host as it influences the speed of maturation of the infectious agent transferred. The launch of the Soil Moisture Active Passive (SMAP) satellite in 2015, and the new ECOSTRESS instrument onboard the International Space Station (ISS) in 2018, established the leadership of the National Aeronautics Space Administration (NASA) in ecology and climate research by allowing the structural and functional classification of ecosystems that govern vector sustainability. These advances, and the availability of sub-meter resolution data from commercial satellites, contribute to seamless mapping and modelling of diseases, not only at continental scales (1 km2) and local community or agricultural field scales (15&amp;ndash;30 m2), but for the first time, also at the habitat&amp;ndash;household scale (&amp;lt;1 m2). This communication presents current capabilities that are related to data collection by Earth-observing satellites, and draws attention to the usefulness of geographical information systems (GIS) and modelling for the study of important parasitic diseases.TropicalMed, Vol. 4, Pages 15: Use of Geospatial Surveillance and Response Systems for Vector-Borne Diseases in the Elimination Phase

The distribution of diseases caused by vector-borne viruses and parasites are restricted by the environmental requirements of their vectors, but also by the ambient temperature inside the host as it influences the speed of maturation of the infectious agent transferred. The launch of the Soil Moisture Active Passive (SMAP) satellite in 2015, and the new ECOSTRESS instrument onboard the International Space Station (ISS) in 2018, established the leadership of the National Aeronautics Space Administration (NASA) in ecology and climate research by allowing the structural and functional classification of ecosystems that govern vector sustainability. These advances, and the availability of sub-meter resolution data from commercial satellites, contribute to seamless mapping and modelling of diseases, not only at continental scales (1 km2) and local community or agricultural field scales (15&amp;ndash;30 m2), but for the first time, also at the habitat&amp;ndash;household scale (&amp;lt;1 m2). This communication presents current capabilities that are related to data collection by Earth-observing satellites, and draws attention to the usefulness of geographical information systems (GIS) and modelling for the study of important parasitic diseases.

]]>Use of Geospatial Surveillance and Response Systems for Vector-Borne Diseases in the Elimination PhaseJohn B. MaloneRobert BergquistMoara MartinsJeffrey C. Luvalldoi: 10.3390/tropicalmed4010015Tropical Medicine and Infectious Disease2019-01-18Tropical Medicine and Infectious Disease2019-01-1841Review1510.3390/tropicalmed4010015http://www.mdpi.com/2414-6366/4/1/15TropicalMed, Vol. 4, Pages 14: Nosocomial Pathogens: An In-Depth Analysis of the Vectorial Potential of Cockroacheshttp://www.mdpi.com/2414-6366/4/1/14
Nosocomial or healthcare-associated infections are regarded as the most frequent adverse event that threatens patients’ safety and has serious economic and social consequences. Cockroach infestation is common in many hospitals, especially in the developing world. Common nosocomial pathogens isolated from cockroaches include Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. Cockroaches also harbor epidemiologically significant antibiotic-resistant organisms, such as carbapenem-resistant Enterobacteriaceae, which complicate nosocomial infections. Therefore, cockroaches constitute an important vector for nosocomial pathogens, and there should be zero tolerance for their presence in healthcare facilities. This paper aims to elucidate the possible role of cockroaches in nosocomial infections by reviewing the relevant research publications.TropicalMed, Vol. 4, Pages 14: Nosocomial Pathogens: An In-Depth Analysis of the Vectorial Potential of Cockroaches

Nosocomial or healthcare-associated infections are regarded as the most frequent adverse event that threatens patients’ safety and has serious economic and social consequences. Cockroach infestation is common in many hospitals, especially in the developing world. Common nosocomial pathogens isolated from cockroaches include Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. Cockroaches also harbor epidemiologically significant antibiotic-resistant organisms, such as carbapenem-resistant Enterobacteriaceae, which complicate nosocomial infections. Therefore, cockroaches constitute an important vector for nosocomial pathogens, and there should be zero tolerance for their presence in healthcare facilities. This paper aims to elucidate the possible role of cockroaches in nosocomial infections by reviewing the relevant research publications.

]]>Nosocomial Pathogens: An In-Depth Analysis of the Vectorial Potential of CockroachesEric S. Donkordoi: 10.3390/tropicalmed4010014Tropical Medicine and Infectious Disease2019-01-17Tropical Medicine and Infectious Disease2019-01-1741Review1410.3390/tropicalmed4010014http://www.mdpi.com/2414-6366/4/1/14TropicalMed, Vol. 4, Pages 13: Cross-Generational Effects of Heat Stress on Fitness and Wolbachia Density in Aedes aegypti Mosquitoeshttp://www.mdpi.com/2414-6366/4/1/13
Aedes aegypti mosquitoes infected with Wolbachia symbionts are now being released into the field to control the spread of pathogenic human arboviruses. Wolbachia can spread throughout vector populations by inducing cytoplasmic incompatibility and can reduce disease transmission by interfering with virus replication. The success of this strategy depends on the effects of Wolbachia on mosquito fitness and the stability of Wolbachia infections across generations. Wolbachia infections are vulnerable to heat stress, and sustained periods of hot weather in the field may influence their utility as disease control agents, particularly if temperature effects persist across generations. To investigate the cross-generational effects of heat stress on Wolbachia density and mosquito fitness, we subjected Ae. aegypti with two different Wolbachia infection types (wMel, wAlbB) and uninfected controls to cyclical heat stress during larval development over two generations. We then tested adult starvation tolerance and wing length as measures of fitness and measured the density of wMel in adults. Both heat stress and Wolbachia infection reduced adult starvation tolerance. wMel Wolbachia density in female offspring was lower when mothers experienced heat stress, but male Wolbachia density did not depend on the rearing temperature of the previous generation. We also found cross-generational effects of heat stress on female starvation tolerance, but there was no cross-generational effect on wing length. Fitness costs of Wolbachia infections and cross-generational effects of heat stress on Wolbachia density may reduce the ability of Wolbachia to invade populations and control arbovirus transmission under specific environmental conditions.TropicalMed, Vol. 4, Pages 13: Cross-Generational Effects of Heat Stress on Fitness and Wolbachia Density in Aedes aegypti Mosquitoes

Aedes aegypti mosquitoes infected with Wolbachia symbionts are now being released into the field to control the spread of pathogenic human arboviruses. Wolbachia can spread throughout vector populations by inducing cytoplasmic incompatibility and can reduce disease transmission by interfering with virus replication. The success of this strategy depends on the effects of Wolbachia on mosquito fitness and the stability of Wolbachia infections across generations. Wolbachia infections are vulnerable to heat stress, and sustained periods of hot weather in the field may influence their utility as disease control agents, particularly if temperature effects persist across generations. To investigate the cross-generational effects of heat stress on Wolbachia density and mosquito fitness, we subjected Ae. aegypti with two different Wolbachia infection types (wMel, wAlbB) and uninfected controls to cyclical heat stress during larval development over two generations. We then tested adult starvation tolerance and wing length as measures of fitness and measured the density of wMel in adults. Both heat stress and Wolbachia infection reduced adult starvation tolerance. wMel Wolbachia density in female offspring was lower when mothers experienced heat stress, but male Wolbachia density did not depend on the rearing temperature of the previous generation. We also found cross-generational effects of heat stress on female starvation tolerance, but there was no cross-generational effect on wing length. Fitness costs of Wolbachia infections and cross-generational effects of heat stress on Wolbachia density may reduce the ability of Wolbachia to invade populations and control arbovirus transmission under specific environmental conditions.

]]>Cross-Generational Effects of Heat Stress on Fitness and Wolbachia Density in Aedes aegypti MosquitoesIsabelle Jia-Hui FooAry A. HoffmannPerran A. Rossdoi: 10.3390/tropicalmed4010013Tropical Medicine and Infectious Disease2019-01-13Tropical Medicine and Infectious Disease2019-01-1341Article1310.3390/tropicalmed4010013http://www.mdpi.com/2414-6366/4/1/13TropicalMed, Vol. 4, Pages 12: Accounting for Healthcare-Seeking Behaviours and Testing Practices in Real-Time Influenza Forecastshttp://www.mdpi.com/2414-6366/4/1/12
For diseases such as influenza, where the majority of infected persons experience mild (if any) symptoms, surveillance systems are sensitive to changes in healthcare-seeking and clinical decision-making behaviours. This presents a challenge when trying to interpret surveillance data in near-real-time (e.g., to provide public health decision-support). Australia experienced a particularly large and severe influenza season in 2017, perhaps in part due to: (a) mild cases being more likely to seek healthcare; and (b) clinicians being more likely to collect specimens for reverse transcription polymerase chain reaction (RT-PCR) influenza tests. In this study, we used weekly Flutracking surveillance data to estimate the probability that a person with influenza-like illness (ILI) would seek healthcare and have a specimen collected. We then used this estimated probability to calibrate near-real-time seasonal influenza forecasts at each week of the 2017 season, to see whether predictive skill could be improved. While the number of self-reported influenza tests in the weekly surveys are typically very low, we were able to detect a substantial change in healthcare seeking behaviour and clinician testing behaviour prior to the high epidemic peak. Adjusting for these changes in behaviour in the forecasting framework improved predictive skill. Our analysis demonstrates a unique value of community-level surveillance systems, such as Flutracking, when interpreting traditional surveillance data. These methods are also applicable beyond the Australian context, as similar community-level surveillance systems operate in other countries.TropicalMed, Vol. 4, Pages 12: Accounting for Healthcare-Seeking Behaviours and Testing Practices in Real-Time Influenza Forecasts

For diseases such as influenza, where the majority of infected persons experience mild (if any) symptoms, surveillance systems are sensitive to changes in healthcare-seeking and clinical decision-making behaviours. This presents a challenge when trying to interpret surveillance data in near-real-time (e.g., to provide public health decision-support). Australia experienced a particularly large and severe influenza season in 2017, perhaps in part due to: (a) mild cases being more likely to seek healthcare; and (b) clinicians being more likely to collect specimens for reverse transcription polymerase chain reaction (RT-PCR) influenza tests. In this study, we used weekly Flutracking surveillance data to estimate the probability that a person with influenza-like illness (ILI) would seek healthcare and have a specimen collected. We then used this estimated probability to calibrate near-real-time seasonal influenza forecasts at each week of the 2017 season, to see whether predictive skill could be improved. While the number of self-reported influenza tests in the weekly surveys are typically very low, we were able to detect a substantial change in healthcare seeking behaviour and clinician testing behaviour prior to the high epidemic peak. Adjusting for these changes in behaviour in the forecasting framework improved predictive skill. Our analysis demonstrates a unique value of community-level surveillance systems, such as Flutracking, when interpreting traditional surveillance data. These methods are also applicable beyond the Australian context, as similar community-level surveillance systems operate in other countries.

]]>Accounting for Healthcare-Seeking Behaviours and Testing Practices in Real-Time Influenza ForecastsRobert MossAlexander E. ZarebskiSandra J. CarlsonJames M. McCawdoi: 10.3390/tropicalmed4010012Tropical Medicine and Infectious Disease2019-01-11Tropical Medicine and Infectious Disease2019-01-1141Article1210.3390/tropicalmed4010012http://www.mdpi.com/2414-6366/4/1/12TropicalMed, Vol. 4, Pages 11: WIPO Re:Search—A Platform for Product-Centered Cross-Sector Partnerships for the Elimination of Schistosomiasishttp://www.mdpi.com/2414-6366/4/1/11
Schistosomiasis is an acute and chronic disease that affects over 200 million people worldwide, and with over 700 million people estimated to be at risk of contracting this disease, it is a pressing issue in global health. However, research and development (R&amp;amp;D) to develop new approaches to preventing, diagnosing, and treating schistosomiasis has been relatively limited. Praziquantel, a drug developed in the 1970s, is the only agent used in schistosomiasis mass drug administration (MDA) campaigns, indicating a critical need for a diversified therapeutic pipeline. Further, gaps in the vaccine and diagnostic pipelines demonstrate a need for early-stage innovation in all areas of schistosomiasis product R&amp;amp;D. As a platform for public-private partnerships (PPPs), the WIPO Re:Search consortium engages the private sector in early-stage R&amp;amp;D for neglected diseases by forging mutually beneficial collaborations and facilitating the sharing of intellectual property (IP) assets between the for-profit and academic/non-profit sectors. The Consortium connects people, resources, and ideas to fill gaps in neglected disease product development pipelines by leveraging the strengths of these two sectors. Using WIPO Re:Search as an example, this article highlights the opportunities for the PPP model to play a key role in the elimination of schistosomiasis.TropicalMed, Vol. 4, Pages 11: WIPO Re:Search—A Platform for Product-Centered Cross-Sector Partnerships for the Elimination of Schistosomiasis

Schistosomiasis is an acute and chronic disease that affects over 200 million people worldwide, and with over 700 million people estimated to be at risk of contracting this disease, it is a pressing issue in global health. However, research and development (R&amp;amp;D) to develop new approaches to preventing, diagnosing, and treating schistosomiasis has been relatively limited. Praziquantel, a drug developed in the 1970s, is the only agent used in schistosomiasis mass drug administration (MDA) campaigns, indicating a critical need for a diversified therapeutic pipeline. Further, gaps in the vaccine and diagnostic pipelines demonstrate a need for early-stage innovation in all areas of schistosomiasis product R&amp;amp;D. As a platform for public-private partnerships (PPPs), the WIPO Re:Search consortium engages the private sector in early-stage R&amp;amp;D for neglected diseases by forging mutually beneficial collaborations and facilitating the sharing of intellectual property (IP) assets between the for-profit and academic/non-profit sectors. The Consortium connects people, resources, and ideas to fill gaps in neglected disease product development pipelines by leveraging the strengths of these two sectors. Using WIPO Re:Search as an example, this article highlights the opportunities for the PPP model to play a key role in the elimination of schistosomiasis.

]]>WIPO Re:Search—A Platform for Product-Centered Cross-Sector Partnerships for the Elimination of SchistosomiasisCallie J. WeberJoseph Hargan-CalvopiñaKaty M. GraefCathyryne K. MannerJennifer Dentdoi: 10.3390/tropicalmed4010011Tropical Medicine and Infectious Disease2019-01-09Tropical Medicine and Infectious Disease2019-01-0941Opinion1110.3390/tropicalmed4010011http://www.mdpi.com/2414-6366/4/1/11TropicalMed, Vol. 4, Pages 10: The Role of Routine Culture in the Treatment of Chronic Suppurative Otitis Media: Implications for the Standard of Care in Rural Areas of South Africahttp://www.mdpi.com/2414-6366/4/1/10
Chronic Suppurative Otitis Media (CSOM) is a widely prevalent disease, which is a leading cause of acquired deafness worldwide, and is associated with complications with significant mortality and morbidity. It often responds poorly to standard of care therapy and places a disproportionate burden on at-risk populations. The microbiology and antibiotic resistance of CSOM varies based on local factors, including health care access, comorbidities, and antibiotic prescribing practices. We evaluated the role and feasibility of using routine culture for the treatment of CSOM in rural areas as a means of improving treatment of CSOM. More than 400 patients were screened in a rural clinic in South Africa over six weeks, and 14 met study criteria and consented for participation. Gram-negative organisms predominated overall, although Staphylococcus aureus was the most commonly isolated single species. A majority of the pathogens were relatively sensitive to commonly prescribed antibiotics, but two cases of methicillin resistant Staphylococcus aureus were cultured, and one patient grew a Scedosporium species. Treatment on follow-up was able to be directed by culture results, suggesting routine culture at the initial point of contact with the health care system may play a pivotal role in addressing this widely prevalent and devastating disease.TropicalMed, Vol. 4, Pages 10: The Role of Routine Culture in the Treatment of Chronic Suppurative Otitis Media: Implications for the Standard of Care in Rural Areas of South Africa

Chronic Suppurative Otitis Media (CSOM) is a widely prevalent disease, which is a leading cause of acquired deafness worldwide, and is associated with complications with significant mortality and morbidity. It often responds poorly to standard of care therapy and places a disproportionate burden on at-risk populations. The microbiology and antibiotic resistance of CSOM varies based on local factors, including health care access, comorbidities, and antibiotic prescribing practices. We evaluated the role and feasibility of using routine culture for the treatment of CSOM in rural areas as a means of improving treatment of CSOM. More than 400 patients were screened in a rural clinic in South Africa over six weeks, and 14 met study criteria and consented for participation. Gram-negative organisms predominated overall, although Staphylococcus aureus was the most commonly isolated single species. A majority of the pathogens were relatively sensitive to commonly prescribed antibiotics, but two cases of methicillin resistant Staphylococcus aureus were cultured, and one patient grew a Scedosporium species. Treatment on follow-up was able to be directed by culture results, suggesting routine culture at the initial point of contact with the health care system may play a pivotal role in addressing this widely prevalent and devastating disease.

]]>The Role of Routine Culture in the Treatment of Chronic Suppurative Otitis Media: Implications for the Standard of Care in Rural Areas of South AfricaJulia TomanAnthony MollMelynda BarnesSheela ShenoiJ. Zachary Porterfielddoi: 10.3390/tropicalmed4010010Tropical Medicine and Infectious Disease2019-01-08Tropical Medicine and Infectious Disease2019-01-0841Article1010.3390/tropicalmed4010010http://www.mdpi.com/2414-6366/4/1/10TropicalMed, Vol. 4, Pages 9: Acknowledgement to Reviewers of Tropical Medicine and Infectious Disease in 2018http://www.mdpi.com/2414-6366/4/1/9
Rigorous peer-review is the corner-stone of high-quality academic publishing. [...]TropicalMed, Vol. 4, Pages 9: Acknowledgement to Reviewers of Tropical Medicine and Infectious Disease in 2018

Rigorous peer-review is the corner-stone of high-quality academic publishing. [...]

]]>Acknowledgement to Reviewers of Tropical Medicine and Infectious Disease in 2018 TropicalMed Editorial Officedoi: 10.3390/tropicalmed4010009Tropical Medicine and Infectious Disease2019-01-08Tropical Medicine and Infectious Disease2019-01-0841Editorial910.3390/tropicalmed4010009http://www.mdpi.com/2414-6366/4/1/9TropicalMed, Vol. 4, Pages 8: Presence of Burkholderia pseudomallei in the ‘Granary of Myanmar’http://www.mdpi.com/2414-6366/4/1/8
Melioidosis is a frequently fatal infectious disease caused by the Gram negative bacillus Burkholderia pseudomallei. Although it was originally discovered in Myanmar, the disease disappeared from sight for many decades. This study focuses on detection of B. pseudomallei in soil in selected sampling sites in an attempt to start to fill the gaps in the current status of our knowledge of the geographical distribution of B. pseudomallei in soil in Myanmar. This cross-sectional study consists of 400 soil samples from 10 selected study townships from two major paddy growing regions. Bacterial isolation was done using a simplified method for the isolation of Burkholderia pseudomallei from soil. In this study, only 1% (4/400) of soil samples were found to be positive; two of four were found at 90 cm depth and another two positive samples were found at 30 cm and 60 cm. This survey has confirmed the presence of environmental B. pseudomallei in Myanmar indicating that the conditions are in place for melioidosis acquisition.TropicalMed, Vol. 4, Pages 8: Presence of Burkholderia pseudomallei in the ‘Granary of Myanmar’

Melioidosis is a frequently fatal infectious disease caused by the Gram negative bacillus Burkholderia pseudomallei. Although it was originally discovered in Myanmar, the disease disappeared from sight for many decades. This study focuses on detection of B. pseudomallei in soil in selected sampling sites in an attempt to start to fill the gaps in the current status of our knowledge of the geographical distribution of B. pseudomallei in soil in Myanmar. This cross-sectional study consists of 400 soil samples from 10 selected study townships from two major paddy growing regions. Bacterial isolation was done using a simplified method for the isolation of Burkholderia pseudomallei from soil. In this study, only 1% (4/400) of soil samples were found to be positive; two of four were found at 90 cm depth and another two positive samples were found at 30 cm and 60 cm. This survey has confirmed the presence of environmental B. pseudomallei in Myanmar indicating that the conditions are in place for melioidosis acquisition.

]]>Presence of Burkholderia pseudomallei in the ‘Granary of Myanmar’Tun Tun WinKhine Khine SuAye Min ThanZaw Min HtutKhin Phyu PyarElizabeth A. AshleyDavid A. B. DanceKyaw Myo Tundoi: 10.3390/tropicalmed4010008Tropical Medicine and Infectious Disease2019-01-04Tropical Medicine and Infectious Disease2019-01-0441Article810.3390/tropicalmed4010008http://www.mdpi.com/2414-6366/4/1/8TropicalMed, Vol. 4, Pages 7: Clostridium difficile in Asia: Opportunities for One Health Managementhttp://www.mdpi.com/2414-6366/4/1/7
Clostridium difficile is a ubiquitous spore-forming bacterium which causes toxin-mediated diarrhoea and colitis in people whose gut microflora has been depleted by antimicrobial use, so it is a predominantly healthcare-associated disease. However, there are many One Health implications to C. difficile, given high colonisation rates in food production animals, contamination of outdoor environments by use of contaminated animal manure, increasing incidence of community-associated C. difficile infection (CDI), and demonstration of clonal groups of C. difficile shared between human clinical cases and food animals. In Asia, the epidemiology of CDI is not well understood given poor testing practices in many countries. The growing middle-class populations of Asia are presenting increasing demands for meat, thus production farming, particularly of pigs, chicken and cattle, is rapidly expanding in Asian countries. Few reports on C. difficile colonisation among production animals in Asia exist, but those that do show high prevalence rates, and possible importation of European strains of C. difficile like ribotype 078. This review summarises our current understanding of the One Health aspects of the epidemiology of CDI in Asia.TropicalMed, Vol. 4, Pages 7: Clostridium difficile in Asia: Opportunities for One Health Management

Clostridium difficile is a ubiquitous spore-forming bacterium which causes toxin-mediated diarrhoea and colitis in people whose gut microflora has been depleted by antimicrobial use, so it is a predominantly healthcare-associated disease. However, there are many One Health implications to C. difficile, given high colonisation rates in food production animals, contamination of outdoor environments by use of contaminated animal manure, increasing incidence of community-associated C. difficile infection (CDI), and demonstration of clonal groups of C. difficile shared between human clinical cases and food animals. In Asia, the epidemiology of CDI is not well understood given poor testing practices in many countries. The growing middle-class populations of Asia are presenting increasing demands for meat, thus production farming, particularly of pigs, chicken and cattle, is rapidly expanding in Asian countries. Few reports on C. difficile colonisation among production animals in Asia exist, but those that do show high prevalence rates, and possible importation of European strains of C. difficile like ribotype 078. This review summarises our current understanding of the One Health aspects of the epidemiology of CDI in Asia.

]]>Clostridium difficile in Asia: Opportunities for One Health ManagementDeirdre A. CollinsThomas V. Rileydoi: 10.3390/tropicalmed4010007Tropical Medicine and Infectious Disease2018-12-28Tropical Medicine and Infectious Disease2018-12-2841Review710.3390/tropicalmed4010007http://www.mdpi.com/2414-6366/4/1/7TropicalMed, Vol. 4, Pages 6: Acute Retroviral Syndrome Presenting with Hemolytic Anemia Induced by G6PD Deficiencyhttp://www.mdpi.com/2414-6366/4/1/6
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme defect described in humans. Hemolysis in affected patients is usually triggered by circumstances involving free radical damage. While acute HIV infection is known to be a state of overwhelming oxidative stress, virus-induced hemolytic events in G6PD-deficient patients has rarely been reported. Despite an estimated overall prevalence of 6.8%&amp;ndash;13% of this disorder in the HIV population, clinically significant hemolysis has been largely attributed to the use of offending medications rather than HIV infection itself. Here, we present a patient whose first episode of G6PD deficiency-associated hemolysis occurred as the main presentation of acute HIV infection.TropicalMed, Vol. 4, Pages 6: Acute Retroviral Syndrome Presenting with Hemolytic Anemia Induced by G6PD Deficiency

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme defect described in humans. Hemolysis in affected patients is usually triggered by circumstances involving free radical damage. While acute HIV infection is known to be a state of overwhelming oxidative stress, virus-induced hemolytic events in G6PD-deficient patients has rarely been reported. Despite an estimated overall prevalence of 6.8%&amp;ndash;13% of this disorder in the HIV population, clinically significant hemolysis has been largely attributed to the use of offending medications rather than HIV infection itself. Here, we present a patient whose first episode of G6PD deficiency-associated hemolysis occurred as the main presentation of acute HIV infection.

]]>Acute Retroviral Syndrome Presenting with Hemolytic Anemia Induced by G6PD DeficiencyTiago AraujoVatsala KatiyarJose A. Gonzales Zamoradoi: 10.3390/tropicalmed4010006Tropical Medicine and Infectious Disease2018-12-27Tropical Medicine and Infectious Disease2018-12-2741Case Report610.3390/tropicalmed4010006http://www.mdpi.com/2414-6366/4/1/6TropicalMed, Vol. 4, Pages 5: Cost of Caregivers for Treating Hospitalized Diarrheal Patients in Bangladeshhttp://www.mdpi.com/2414-6366/4/1/5
Introduction: Diarrheal diseases are a global public health problem and one of the leading causes of mortality, morbidity and economic loss. The objective of the study is to estimate the economic cost of caregivers and cost distribution per diarrheal episodes in Bangladesh. Methods: This was a cross-sectional hospital-based study conducted in public hospitals in Bangladesh. A total of 801 diarrheal patients were randomly selected and interviewed during January to December 2015. Simple descriptive statistics including frequencies, percentage, mean with 95% CI and median are presented. Results: The overall average cost of caregivers was BDT 2243 (US$ 28.58) while only BDT 259 (US$ 3.29) was spent as out of pocket payments. Caregivers mostly spent money (US$ 1.63) for food, lodging, utility bills, and other lump sum costs followed by the transportation costs (US$ 1.57). The caregivers spent more (US$ 44.45) when they accompanied the patients who were admitted in inpatients care and almost 3.6 times higher than for out-patients care (US$ 12.42). Conclusions: The study delivers an empirical evidence to the health-care programmers and policy makers about the economic cost of caregivers during diarrheal treatment care, which should be accounted for in designing future diarrheal prevention programme.TropicalMed, Vol. 4, Pages 5: Cost of Caregivers for Treating Hospitalized Diarrheal Patients in Bangladesh

Introduction: Diarrheal diseases are a global public health problem and one of the leading causes of mortality, morbidity and economic loss. The objective of the study is to estimate the economic cost of caregivers and cost distribution per diarrheal episodes in Bangladesh. Methods: This was a cross-sectional hospital-based study conducted in public hospitals in Bangladesh. A total of 801 diarrheal patients were randomly selected and interviewed during January to December 2015. Simple descriptive statistics including frequencies, percentage, mean with 95% CI and median are presented. Results: The overall average cost of caregivers was BDT 2243 (US$ 28.58) while only BDT 259 (US$ 3.29) was spent as out of pocket payments. Caregivers mostly spent money (US$ 1.63) for food, lodging, utility bills, and other lump sum costs followed by the transportation costs (US$ 1.57). The caregivers spent more (US$ 44.45) when they accompanied the patients who were admitted in inpatients care and almost 3.6 times higher than for out-patients care (US$ 12.42). Conclusions: The study delivers an empirical evidence to the health-care programmers and policy makers about the economic cost of caregivers during diarrheal treatment care, which should be accounted for in designing future diarrheal prevention programme.

Medical teaching has emphasised over many years the uniqueness of disease states, valuing the rare skills on which the art of diagnosis is based and the intricacies of individual patient-centred management. [...]

]]>Skin-Related Neglected Tropical Diseases (Skin NTDs)—A New ChallengeRoderick J. HayKingsley Asiedudoi: 10.3390/tropicalmed4010004Tropical Medicine and Infectious Disease2018-12-25Tropical Medicine and Infectious Disease2018-12-2541Editorial410.3390/tropicalmed4010004http://www.mdpi.com/2414-6366/4/1/4TropicalMed, Vol. 4, Pages 3: Action towards Universal Health Coverage and Social Protection for Tuberculosis Care and Prevention: Workshop on the End TB Strategy Pillar 2 in the Western Pacific Region 2017http://www.mdpi.com/2414-6366/4/1/3
Although the End TB Strategy highlights that major global progress towards universal health coverage (UHC) and social protection are fundamental to achieving the global targets for reductions in tuberculosis (TB) incidence and deaths, there is still a long way to go to achieve them in low- and middle-income countries. A workshop on the End TB Strategy Pillar 2 in the Western Pacific Region focusing on action towards UHC and social protection was held between 27 and 29 November in 2017 at the Korean Institute of Tuberculosis in Cheonju, Republic of Korea. The workshop brought together key personnel from national TB programmes and other stakeholders or researchers with experience in this topic from six countries with a high burden of TB in the region. During the workshop, participants shared country experiences, best practices, and challenges in achieving UHC and enhancing social protection in the context of TB service delivery, and also explored policy options to address the challenges, to be applied in their respective countries. This report describes the content of the meeting and the conclusions and recommendations arising from the meeting.TropicalMed, Vol. 4, Pages 3: Action towards Universal Health Coverage and Social Protection for Tuberculosis Care and Prevention: Workshop on the End TB Strategy Pillar 2 in the Western Pacific Region 2017

Although the End TB Strategy highlights that major global progress towards universal health coverage (UHC) and social protection are fundamental to achieving the global targets for reductions in tuberculosis (TB) incidence and deaths, there is still a long way to go to achieve them in low- and middle-income countries. A workshop on the End TB Strategy Pillar 2 in the Western Pacific Region focusing on action towards UHC and social protection was held between 27 and 29 November in 2017 at the Korean Institute of Tuberculosis in Cheonju, Republic of Korea. The workshop brought together key personnel from national TB programmes and other stakeholders or researchers with experience in this topic from six countries with a high burden of TB in the region. During the workshop, participants shared country experiences, best practices, and challenges in achieving UHC and enhancing social protection in the context of TB service delivery, and also explored policy options to address the challenges, to be applied in their respective countries. This report describes the content of the meeting and the conclusions and recommendations arising from the meeting.

]]>Action towards Universal Health Coverage and Social Protection for Tuberculosis Care and Prevention: Workshop on the End TB Strategy Pillar 2 in the Western Pacific Region 2017Kyung OhKalpeshsinh RahevarNobuyuki NishikioriKerri VineyHongjo ChoiOlivia BiermannHee KimChanly NouSamoeun KimGe ZhuHui ZhangCaihong XuSoth BounmalaMaytry SenchanthixayEnkhtamir PurevdorjUlzii-orshikh KhaltarRonald PaguiriganHansel AmoguisVu Xuan PhuDang Khangdoi: 10.3390/tropicalmed4010003Tropical Medicine and Infectious Disease2018-12-24Tropical Medicine and Infectious Disease2018-12-2441Meeting Report310.3390/tropicalmed4010003http://www.mdpi.com/2414-6366/4/1/3TropicalMed, Vol. 4, Pages 2: Evolution of Tuberculosis/Human Immunodeficiency Virus Services among Different Integrated Models in Myanmar: A Health Services Reviewhttp://www.mdpi.com/2414-6366/4/1/2
Myanmar is one of the highly affected countries by tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection. We aimed to review the coverage of TB/HIV integrated services as well as to document the performance of this integrated services. A retrospective program review was conducted using the aggregated data of the National TB Programme (NTP) from 2005 to 2016. In Myanmar, TB/HIV services were initiated in seven townships in 2005. Townships were slowly expanded until 2013. After that, the momentum was increased by increasing the government budget allocation for NTP. In 2016, the whole country was eventually covered by TB/HIV services in different types of integration. Antiretroviral therapy (ART) coverage among HIV-positive TB patients remained low and it was the only significant difference among the three types of integration. Barriers of low ART coverage need to be investigated to reduce the burden of TB/HIV.TropicalMed, Vol. 4, Pages 2: Evolution of Tuberculosis/Human Immunodeficiency Virus Services among Different Integrated Models in Myanmar: A Health Services Review

Myanmar is one of the highly affected countries by tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection. We aimed to review the coverage of TB/HIV integrated services as well as to document the performance of this integrated services. A retrospective program review was conducted using the aggregated data of the National TB Programme (NTP) from 2005 to 2016. In Myanmar, TB/HIV services were initiated in seven townships in 2005. Townships were slowly expanded until 2013. After that, the momentum was increased by increasing the government budget allocation for NTP. In 2016, the whole country was eventually covered by TB/HIV services in different types of integration. Antiretroviral therapy (ART) coverage among HIV-positive TB patients remained low and it was the only significant difference among the three types of integration. Barriers of low ART coverage need to be investigated to reduce the burden of TB/HIV.

Two cases of cryptococcal meningitis went undetected by a cryptococcal antigen (CrAg) lateral flow assay on blood in a reflex CrAg screen-and-treat programme in South Africa, although Cryptococcus neoformans was identified by culturing the cerebrospinal fluid specimens. Further investigations into these discordant diagnostic results included multilocus sequence typing (which showed no mutations in the CAP59 gene) and transmission electron microscopy using a capsule-staining protocol (which revealed a &amp;gt;50% reduction in capsular material in both cases, relative to a control culture). A multi-disciplinary approach for resolving discordant diagnostic test results is recommended.

]]>Cryptococcus neoformans: Diagnostic Dilemmas, Electron Microscopy and Capsular VariantsMonica BirkheadSerisha D. NaickerNozuko P. BlasichIvy RukashaJuno ThomasCharlotte SriruttanShareef AbrahamsGrisselda S. MavusoNelesh P. Govenderdoi: 10.3390/tropicalmed4010001Tropical Medicine and Infectious Disease2018-12-20Tropical Medicine and Infectious Disease2018-12-2041Case Report110.3390/tropicalmed4010001http://www.mdpi.com/2414-6366/4/1/1TropicalMed, Vol. 3, Pages 127: Phylogeography of Bulinus truncatus (Audouin, 1827) (Gastropoda: Planorbidae) in Selected African Countrieshttp://www.mdpi.com/2414-6366/3/4/127
The transmission of some schistosome parasites is dependent on the planorbid snail hosts. Bulinus truncatus is important in urinary schistosomiasis epidemiology in Africa. Hence, there is a need to define the snails&amp;rsquo; phylogeography. This study assessed the population genetic structure of B. truncatus from Giza and Sharkia (Egypt), Barakat (Sudan) and Madziwa, Shamva District (Zimbabwe) using mitochondrial cytochrome oxidase subunit 1 gene (COI) and internal transcribed spacer 1 (ITS 1) markers. COI was sequenced from 94 B. truncatus samples including 38 (Egypt), 36 (Sudan) and 20 (Zimbabwe). However, only 51 ITS 1 sequences were identified from Egypt (28) and Sudan (23) (because of failure in either amplification or sequencing). The unique COI haplotypes of B. truncatus sequences observed were 6, 11, and 6 for Egypt, Sudan, and Zimbabwe, respectively. Also, 3 and 2 unique ITS 1 haplotypes were observed in sequences from Egypt and Sudan respectively. Mitochondrial DNA sequences from Sudan and Zimbabwe indicated high haplotype diversity with 0.768 and 0.784, respectively, while relatively low haplotype diversity was also observed for sequences from Egypt (0.334). The location of populations from Egypt and Sudan on the B. truncatus clade agrees with the location of both countries geographically. The clustering of the Zimbabwe sequences on different locations on the clade can be attributed to individuals with different genotypes within the population. No significant variation was observed within B. truncatus populations from Egypt and Sudan as indicated by the ITS 1 tree. This study investigated the genetic diversity of B. truncatus from Giza and Sharkia (Egypt), Barakat area (Sudan), and Madziwa (Zimbabwe), which is necessary for snail host surveillance in the study areas and also provided genomic data of this important snail species from the sampled countries.TropicalMed, Vol. 3, Pages 127: Phylogeography of Bulinus truncatus (Audouin, 1827) (Gastropoda: Planorbidae) in Selected African Countries

The transmission of some schistosome parasites is dependent on the planorbid snail hosts. Bulinus truncatus is important in urinary schistosomiasis epidemiology in Africa. Hence, there is a need to define the snails&amp;rsquo; phylogeography. This study assessed the population genetic structure of B. truncatus from Giza and Sharkia (Egypt), Barakat (Sudan) and Madziwa, Shamva District (Zimbabwe) using mitochondrial cytochrome oxidase subunit 1 gene (COI) and internal transcribed spacer 1 (ITS 1) markers. COI was sequenced from 94 B. truncatus samples including 38 (Egypt), 36 (Sudan) and 20 (Zimbabwe). However, only 51 ITS 1 sequences were identified from Egypt (28) and Sudan (23) (because of failure in either amplification or sequencing). The unique COI haplotypes of B. truncatus sequences observed were 6, 11, and 6 for Egypt, Sudan, and Zimbabwe, respectively. Also, 3 and 2 unique ITS 1 haplotypes were observed in sequences from Egypt and Sudan respectively. Mitochondrial DNA sequences from Sudan and Zimbabwe indicated high haplotype diversity with 0.768 and 0.784, respectively, while relatively low haplotype diversity was also observed for sequences from Egypt (0.334). The location of populations from Egypt and Sudan on the B. truncatus clade agrees with the location of both countries geographically. The clustering of the Zimbabwe sequences on different locations on the clade can be attributed to individuals with different genotypes within the population. No significant variation was observed within B. truncatus populations from Egypt and Sudan as indicated by the ITS 1 tree. This study investigated the genetic diversity of B. truncatus from Giza and Sharkia (Egypt), Barakat area (Sudan), and Madziwa (Zimbabwe), which is necessary for snail host surveillance in the study areas and also provided genomic data of this important snail species from the sampled countries.

]]>Phylogeography of Bulinus truncatus (Audouin, 1827) (Gastropoda: Planorbidae) in Selected African CountriesEniola M. AbeYun-Hai GuoHaimo ShenMasceline J. Mutsaka-MakuvazaMohamed R. HabibJing-Bo XueNicholas MidziJing XuShi-Zhu LiXiao-Nong Zhoudoi: 10.3390/tropicalmed3040127Tropical Medicine and Infectious Disease2018-12-19Tropical Medicine and Infectious Disease2018-12-1934Article12710.3390/tropicalmed3040127http://www.mdpi.com/2414-6366/3/4/127TropicalMed, Vol. 3, Pages 126: Is Australia Neglecting the Local Topography When It Comes to Catastrophic Costs and Ending Tuberculosis?http://www.mdpi.com/2414-6366/3/4/126
Efforts to eliminate tuberculosis as a public health problem require reductions in mortality, incidence, and the eradication of associated catastrophic costs; however, the question of catastrophic costs is often neglected, particularly in the context of low-incidence settings like Australia. This study reviews the financial support provided to those identified as in need, and in receipt, of economic aid from the Victorian Tuberculosis Program. The study design used Epstein&amp;rsquo;s clinical data mining framework to produce descriptive statistics which were supplemented by clinical collaboration. A consistent one-third of those receiving care from the Program due to a notification of active tuberculosis received emergency financial relief over the study period. Overwhelmingly, funds were used to relieve financial distress, and each year approximately one-third of the expenditure was used to support 2% of those people notified as affected by tuberculosis (or 7&amp;ndash;9% of those in receipt of funds). Many of this 2% experienced income loss and expenditure that may be considered catastrophic. Further investigation is needed to better define and understand the nature of catastrophic costs in the context of universal health care and existing low tuberculosis incidence.TropicalMed, Vol. 3, Pages 126: Is Australia Neglecting the Local Topography When It Comes to Catastrophic Costs and Ending Tuberculosis?

Efforts to eliminate tuberculosis as a public health problem require reductions in mortality, incidence, and the eradication of associated catastrophic costs; however, the question of catastrophic costs is often neglected, particularly in the context of low-incidence settings like Australia. This study reviews the financial support provided to those identified as in need, and in receipt, of economic aid from the Victorian Tuberculosis Program. The study design used Epstein&amp;rsquo;s clinical data mining framework to produce descriptive statistics which were supplemented by clinical collaboration. A consistent one-third of those receiving care from the Program due to a notification of active tuberculosis received emergency financial relief over the study period. Overwhelmingly, funds were used to relieve financial distress, and each year approximately one-third of the expenditure was used to support 2% of those people notified as affected by tuberculosis (or 7&amp;ndash;9% of those in receipt of funds). Many of this 2% experienced income loss and expenditure that may be considered catastrophic. Further investigation is needed to better define and understand the nature of catastrophic costs in the context of universal health care and existing low tuberculosis incidence.

]]>Is Australia Neglecting the Local Topography When It Comes to Catastrophic Costs and Ending Tuberculosis?Krista Wattsdoi: 10.3390/tropicalmed3040126Tropical Medicine and Infectious Disease2018-12-19Tropical Medicine and Infectious Disease2018-12-1934Article12610.3390/tropicalmed3040126http://www.mdpi.com/2414-6366/3/4/126TropicalMed, Vol. 3, Pages 125: Artemether and Praziquantel: Origin, Mode of Action, Impact, and Suggested Application for Effective Control of Human Schistosomiasishttp://www.mdpi.com/2414-6366/3/4/125
The stumbling block for the continued, single-drug use of praziquantel (PZQ) against schistosomiasis is less justified by the risk of drug resistance than by the fact that this drug is inactive against juvenile parasites, which will mature and start egg production after chemotherapy. Artemisinin derivatives, currently used against malaria in the form of artemisinin-based combination therapy (ACT), provide an opportunity as these drugs are not only active against malaria plasmodia, but surprisingly also against juvenile schistosomes. An artemisinin/PZQ combination would be complementary, and potentially additive, as it would kill two schistosome life cycle stages and thus confer a transmission-blocking modality to current chemotherapy. We focus here on single versus combined regimens in endemic settings. Although the risk of artemisinin resistance, already emerging with respect to malaria therapy in Southeast Asia, prevents use in countries where ACT is needed for malaria care, an artemisinin-enforced praziquantel treatment (APT) should be acceptable in regions of North Africa (including Egypt), the Middle East, China, and Brazil that are not endemic for malaria. Thanks to recent progress with respect to high-resolution diagnostics, based on circulating schistosome antigens in humans and molecular approaches for snail surveys, it should be possible to keep areas scheduled for schistosomiasis elimination under surveillance, bringing rapid response to bear on problems arising. The next steps would be to investigate where and for how long APT should be applied to make a lasting impact. A large-scale field trial in an area with modest transmission should tell how apt this approach is.TropicalMed, Vol. 3, Pages 125: Artemether and Praziquantel: Origin, Mode of Action, Impact, and Suggested Application for Effective Control of Human Schistosomiasis

The stumbling block for the continued, single-drug use of praziquantel (PZQ) against schistosomiasis is less justified by the risk of drug resistance than by the fact that this drug is inactive against juvenile parasites, which will mature and start egg production after chemotherapy. Artemisinin derivatives, currently used against malaria in the form of artemisinin-based combination therapy (ACT), provide an opportunity as these drugs are not only active against malaria plasmodia, but surprisingly also against juvenile schistosomes. An artemisinin/PZQ combination would be complementary, and potentially additive, as it would kill two schistosome life cycle stages and thus confer a transmission-blocking modality to current chemotherapy. We focus here on single versus combined regimens in endemic settings. Although the risk of artemisinin resistance, already emerging with respect to malaria therapy in Southeast Asia, prevents use in countries where ACT is needed for malaria care, an artemisinin-enforced praziquantel treatment (APT) should be acceptable in regions of North Africa (including Egypt), the Middle East, China, and Brazil that are not endemic for malaria. Thanks to recent progress with respect to high-resolution diagnostics, based on circulating schistosome antigens in humans and molecular approaches for snail surveys, it should be possible to keep areas scheduled for schistosomiasis elimination under surveillance, bringing rapid response to bear on problems arising. The next steps would be to investigate where and for how long APT should be applied to make a lasting impact. A large-scale field trial in an area with modest transmission should tell how apt this approach is.

]]>Artemether and Praziquantel: Origin, Mode of Action, Impact, and Suggested Application for Effective Control of Human SchistosomiasisRobert BergquistHala Elmorshedydoi: 10.3390/tropicalmed3040125Tropical Medicine and Infectious Disease2018-12-19Tropical Medicine and Infectious Disease2018-12-1934Review12510.3390/tropicalmed3040125http://www.mdpi.com/2414-6366/3/4/125TropicalMed, Vol. 3, Pages 124: Field Evaluation of a Loop-Mediated Isothermal Amplification (LAMP) Platform for the Detection of Schistosoma japonicum Infection in Oncomelania hupensis Snailshttp://www.mdpi.com/2414-6366/3/4/124
Schistosoma infection in snails can be monitored by microscopy or indirectly by sentinel mice. As both these approaches can miss infections, more sensitive tests are needed, particularly in low-level transmission settings. In this study, loop-mediated isothermal amplification (LAMP) technique, designed to detect a specific 28S ribosomal Schistosoma japonicum (Sj28S) gene with high sensitivity, was compared to microscopy using snail samples from 51 areas endemic for schistosomiasis in five Chinese provinces. In addition, the results were compared with those from polymerase chain reaction (PCR) by adding DNA sequencing as a reference. The testing of pooled snail samples with the LAMP assay showed that a dilution factor of 1/50, i.e., one infected snail plus 49 non-infected ones, would still result in a positive reaction after the recommended number of amplification cycles. Testing a total of 232 pooled samples, emanating from 4006 snail specimens, showed a rate of infection of 6.5%, while traditional microscopy found only 0.4% positive samples in the same materials. Parallel PCR analysis confirmed the diagnostic accuracy of the LAMP assay, with DNA sequencing even giving LAMP a slight lead. Microscopy and the LAMP test were carried out at local schistosomiasis-control stations, demonstrating that the potential of the latter assay to serve as a point-of-care (POC) test with results available within 60&amp;ndash;90 min, while the more complicated PCR test had to be carried out at the National Institute of Parasitic Diseases (NIPD) in Shanghai, China. In conclusion, LAMP was found to be clearly superior to microscopy and as good as, or better than, PCR. As it can be used under field conditions and requires less time than other techniques, LAMP testing would improve and accelerate schistosomiasis control.TropicalMed, Vol. 3, Pages 124: Field Evaluation of a Loop-Mediated Isothermal Amplification (LAMP) Platform for the Detection of Schistosoma japonicum Infection in Oncomelania hupensis Snails

Schistosoma infection in snails can be monitored by microscopy or indirectly by sentinel mice. As both these approaches can miss infections, more sensitive tests are needed, particularly in low-level transmission settings. In this study, loop-mediated isothermal amplification (LAMP) technique, designed to detect a specific 28S ribosomal Schistosoma japonicum (Sj28S) gene with high sensitivity, was compared to microscopy using snail samples from 51 areas endemic for schistosomiasis in five Chinese provinces. In addition, the results were compared with those from polymerase chain reaction (PCR) by adding DNA sequencing as a reference. The testing of pooled snail samples with the LAMP assay showed that a dilution factor of 1/50, i.e., one infected snail plus 49 non-infected ones, would still result in a positive reaction after the recommended number of amplification cycles. Testing a total of 232 pooled samples, emanating from 4006 snail specimens, showed a rate of infection of 6.5%, while traditional microscopy found only 0.4% positive samples in the same materials. Parallel PCR analysis confirmed the diagnostic accuracy of the LAMP assay, with DNA sequencing even giving LAMP a slight lead. Microscopy and the LAMP test were carried out at local schistosomiasis-control stations, demonstrating that the potential of the latter assay to serve as a point-of-care (POC) test with results available within 60&amp;ndash;90 min, while the more complicated PCR test had to be carried out at the National Institute of Parasitic Diseases (NIPD) in Shanghai, China. In conclusion, LAMP was found to be clearly superior to microscopy and as good as, or better than, PCR. As it can be used under field conditions and requires less time than other techniques, LAMP testing would improve and accelerate schistosomiasis control.

]]>Field Evaluation of a Loop-Mediated Isothermal Amplification (LAMP) Platform for the Detection of Schistosoma japonicum Infection in Oncomelania hupensis SnailsZhi-Qiang QinJing XuTing FengShan LvYing-Jun QianLi-Juan ZhangYin-Long LiChao LvRobert BergquistShi-Zhu LiXiao-Nong Zhoudoi: 10.3390/tropicalmed3040124Tropical Medicine and Infectious Disease2018-12-15Tropical Medicine and Infectious Disease2018-12-1534Article12410.3390/tropicalmed3040124http://www.mdpi.com/2414-6366/3/4/124TropicalMed, Vol. 3, Pages 123: Fatal Dengue, Chikungunya and Leptospirosis: The Importance of Assessing Co-infections in Febrile Patients in Tropical Areashttp://www.mdpi.com/2414-6366/3/4/123
The febrile patient from tropical areas, in which emerging arboviruses are endemic, represents a diagnostic challenge, and potential co-infections with other pathogens (i.e., bacteria or parasites) are usually overlooked. We present a case of an elderly woman diagnosed with dengue, chikungunya and Leptospira interrogans co-infection. Study Design: Case report. An 87-year old woman from Colombia complained of upper abdominal pain, arthralgia, myalgia, hyporexia, malaise and intermittent fever accompanied with progressive jaundice. She had a medical history of chronic heart failure (Stage C, New York Heart Association, NYHA III), without documented cardiac murmurs, right bundle branch block, non-valvular atrial fibrillation, hypertension, and chronic venous disease. Her cardiac and pulmonary status quickly deteriorated after 24 h of her admission without electrocardiographic changes and she required ventilatory and vasopressor support. In the next hours the patient evolved to pulseless electrical activity and then she died. Dengue immunoglobulin M (IgM), non-structural protein 1 (NS1) enzyme-linked immunosorbent assay (ELISA), microagglutination test (MAT) for Leptospira interrogans and reverse transcription polymerase chain reaction (RT-PCR) for chikungunya, were positive. This case illustrates a multiple co-infection in a febrile patient from a tropical area of Latin America that evolved to death.TropicalMed, Vol. 3, Pages 123: Fatal Dengue, Chikungunya and Leptospirosis: The Importance of Assessing Co-infections in Febrile Patients in Tropical Areas

The febrile patient from tropical areas, in which emerging arboviruses are endemic, represents a diagnostic challenge, and potential co-infections with other pathogens (i.e., bacteria or parasites) are usually overlooked. We present a case of an elderly woman diagnosed with dengue, chikungunya and Leptospira interrogans co-infection. Study Design: Case report. An 87-year old woman from Colombia complained of upper abdominal pain, arthralgia, myalgia, hyporexia, malaise and intermittent fever accompanied with progressive jaundice. She had a medical history of chronic heart failure (Stage C, New York Heart Association, NYHA III), without documented cardiac murmurs, right bundle branch block, non-valvular atrial fibrillation, hypertension, and chronic venous disease. Her cardiac and pulmonary status quickly deteriorated after 24 h of her admission without electrocardiographic changes and she required ventilatory and vasopressor support. In the next hours the patient evolved to pulseless electrical activity and then she died. Dengue immunoglobulin M (IgM), non-structural protein 1 (NS1) enzyme-linked immunosorbent assay (ELISA), microagglutination test (MAT) for Leptospira interrogans and reverse transcription polymerase chain reaction (RT-PCR) for chikungunya, were positive. This case illustrates a multiple co-infection in a febrile patient from a tropical area of Latin America that evolved to death.

]]>Fatal Dengue, Chikungunya and Leptospirosis: The Importance of Assessing Co-infections in Febrile Patients in Tropical AreasJaime A. Cardona-OspinaCarlos E. Jiménez-CanizalesHeriberto Vásquez-SernaJesús Alberto Garzón-RamírezJosé Fair Alarcón-RobayoJuan Alexander Cerón-PinedaAlfonso J. Rodríguez-Moralesdoi: 10.3390/tropicalmed3040123Tropical Medicine and Infectious Disease2018-11-26Tropical Medicine and Infectious Disease2018-11-2634Case Report12310.3390/tropicalmed3040123http://www.mdpi.com/2414-6366/3/4/123TropicalMed, Vol. 3, Pages 122: Eliminating Neglected Tropical Diseases in Urban Areas: A Review of Challenges, Strategies and Research Directions for Successful Mass Drug Administrationhttp://www.mdpi.com/2414-6366/3/4/122
Since 1950, the global urban population grew from 746 million to almost 4 billion and is expected to reach 6.4 billion by mid-century. Almost 90% of this increase will take place in Asia and Africa and disproportionately in urban slums. In this context, concerns about the amplification of several neglected tropical diseases (NTDs) are warranted and efforts towards achieving effective mass drug administration (MDA) coverage become even more important. This narrative review considers the published literature on MDA implementation for specific NTDs and in-country experiences under the ENVISION and END in Africa projects to surface features of urban settings that challenge delivery strategies known to work in rural areas. Discussed under the thematics of governance, population heterogeneity, mobility and community trust in MDA, these features include weak public health infrastructure and programs, challenges related to engaging diverse and dynamic populations and the limited accessibility of certain urban settings such as slums. Although the core components of MDA programs for NTDs in urban settings are similar to those in rural areas, their delivery may need adjustment. Effective coverage of MDA in diverse urban populations can be supported by tailored approaches informed by mapping studies, research that identifies context-specific methods to increase MDA coverage and rigorous monitoring and evaluation.TropicalMed, Vol. 3, Pages 122: Eliminating Neglected Tropical Diseases in Urban Areas: A Review of Challenges, Strategies and Research Directions for Successful Mass Drug Administration

Since 1950, the global urban population grew from 746 million to almost 4 billion and is expected to reach 6.4 billion by mid-century. Almost 90% of this increase will take place in Asia and Africa and disproportionately in urban slums. In this context, concerns about the amplification of several neglected tropical diseases (NTDs) are warranted and efforts towards achieving effective mass drug administration (MDA) coverage become even more important. This narrative review considers the published literature on MDA implementation for specific NTDs and in-country experiences under the ENVISION and END in Africa projects to surface features of urban settings that challenge delivery strategies known to work in rural areas. Discussed under the thematics of governance, population heterogeneity, mobility and community trust in MDA, these features include weak public health infrastructure and programs, challenges related to engaging diverse and dynamic populations and the limited accessibility of certain urban settings such as slums. Although the core components of MDA programs for NTDs in urban settings are similar to those in rural areas, their delivery may need adjustment. Effective coverage of MDA in diverse urban populations can be supported by tailored approaches informed by mapping studies, research that identifies context-specific methods to increase MDA coverage and rigorous monitoring and evaluation.

]]>Eliminating Neglected Tropical Diseases in Urban Areas: A Review of Challenges, Strategies and Research Directions for Successful Mass Drug AdministrationAlayne M. AdamsMyriam VuckovicEleanor BirchTara A. BrantStephanie BialekDahye YoonJoseph KoromaAbdel DirenyJoseph ShottJean Frantz LemoineMassitan DembeleMargaret C. Bakerdoi: 10.3390/tropicalmed3040122Tropical Medicine and Infectious Disease2018-11-21Tropical Medicine and Infectious Disease2018-11-2134Review12210.3390/tropicalmed3040122http://www.mdpi.com/2414-6366/3/4/122TropicalMed, Vol. 3, Pages 121: Current Status of the Sm14/GLA-SE Schistosomiasis Vaccine: Overcoming Barriers and Paradigms towards the First Anti-Parasitic Human(itarian) Vaccinehttp://www.mdpi.com/2414-6366/3/4/121
Schistosomiasis, a disease historically associated with poverty, lack of sanitation and social inequality, is a chronic, debilitating parasitic infection, affecting hundreds of millions of people in endemic countries. Although chemotherapy is capable of reducing morbidity in humans, rapid re-infection demonstrates that the impact of drug treatment on transmission control or disease elimination is marginal. In addition, despite more than two decades of well-executed control activities based on large-scale chemotherapy, the disease is expanding in many areas including Brazil. The development of the Sm14/GLA-SE schistosomiasis vaccine is an emblematic, open knowledge innovation that has successfully completed phase I and phase IIa clinical trials, with Phase II/III trials underway in the African continent, to be followed by further trials in Brazil. The discovery and experimental phases of the development of this vaccine gathered a robust collection of data that strongly supports the ongoing clinical phase. This paper reviews the development of the Sm14 vaccine, formulated with glucopyranosyl lipid A (GLA-SE), from the initial experimental developments to clinical trials including the current status of phase II studies.TropicalMed, Vol. 3, Pages 121: Current Status of the Sm14/GLA-SE Schistosomiasis Vaccine: Overcoming Barriers and Paradigms towards the First Anti-Parasitic Human(itarian) Vaccine

Schistosomiasis, a disease historically associated with poverty, lack of sanitation and social inequality, is a chronic, debilitating parasitic infection, affecting hundreds of millions of people in endemic countries. Although chemotherapy is capable of reducing morbidity in humans, rapid re-infection demonstrates that the impact of drug treatment on transmission control or disease elimination is marginal. In addition, despite more than two decades of well-executed control activities based on large-scale chemotherapy, the disease is expanding in many areas including Brazil. The development of the Sm14/GLA-SE schistosomiasis vaccine is an emblematic, open knowledge innovation that has successfully completed phase I and phase IIa clinical trials, with Phase II/III trials underway in the African continent, to be followed by further trials in Brazil. The discovery and experimental phases of the development of this vaccine gathered a robust collection of data that strongly supports the ongoing clinical phase. This paper reviews the development of the Sm14 vaccine, formulated with glucopyranosyl lipid A (GLA-SE), from the initial experimental developments to clinical trials including the current status of phase II studies.

]]>Current Status of the Sm14/GLA-SE Schistosomiasis Vaccine: Overcoming Barriers and Paradigms towards the First Anti-Parasitic Human(itarian) VaccineMiriam TendlerMarília S. AlmeidaMonica M. VilarPatrícia M. PintoGabriel Limaverde-Sousadoi: 10.3390/tropicalmed3040121Tropical Medicine and Infectious Disease2018-11-21Tropical Medicine and Infectious Disease2018-11-2134Review12110.3390/tropicalmed3040121http://www.mdpi.com/2414-6366/3/4/121TropicalMed, Vol. 3, Pages 120: Integrated Management of Skin NTDs—Lessons Learned from Existing Practice and Field Researchhttp://www.mdpi.com/2414-6366/3/4/120
Integration of neglected tropical diseases (NTDs) into the public health agenda has been a priority in global health for the last decade. Because a number of these diseases share not only the geographical distribution, but also a common feature which is skin involvement, bringing together a sub-group of &amp;lsquo;skin NTDs&amp;rsquo; is one way forward to promote further integration among NTDs. With these diseases, which include leprosy, Buruli ulcer, yaws, mycetoma, lymphatic filariasis, and leishmaniasis, patients may be left with life-long deformities and disabilities when diagnosis and treatment are delayed. Stigma is another serious consequence of skin NTDs as it places a large barrier on the economic activities and social life of a patient. As a result, this creates a vicious cycle and obstructs a key goal of society, the elimination of poverty. Enhancement in surveillance systems as well as the further development of diagnostic methods, improvement in treatment and management, and identification of preventative measures for skin NTDs are therefore urgently needed. This article summarizes the existing practices and field research on skin NTDs and identifies potential synergies that could be achieved by adopting this integrated approach.TropicalMed, Vol. 3, Pages 120: Integrated Management of Skin NTDs—Lessons Learned from Existing Practice and Field Research

Integration of neglected tropical diseases (NTDs) into the public health agenda has been a priority in global health for the last decade. Because a number of these diseases share not only the geographical distribution, but also a common feature which is skin involvement, bringing together a sub-group of &amp;lsquo;skin NTDs&amp;rsquo; is one way forward to promote further integration among NTDs. With these diseases, which include leprosy, Buruli ulcer, yaws, mycetoma, lymphatic filariasis, and leishmaniasis, patients may be left with life-long deformities and disabilities when diagnosis and treatment are delayed. Stigma is another serious consequence of skin NTDs as it places a large barrier on the economic activities and social life of a patient. As a result, this creates a vicious cycle and obstructs a key goal of society, the elimination of poverty. Enhancement in surveillance systems as well as the further development of diagnostic methods, improvement in treatment and management, and identification of preventative measures for skin NTDs are therefore urgently needed. This article summarizes the existing practices and field research on skin NTDs and identifies potential synergies that could be achieved by adopting this integrated approach.

]]>Integrated Management of Skin NTDs—Lessons Learned from Existing Practice and Field ResearchRie R. Yotsudoi: 10.3390/tropicalmed3040120Tropical Medicine and Infectious Disease2018-11-14Tropical Medicine and Infectious Disease2018-11-1434Review12010.3390/tropicalmed3040120http://www.mdpi.com/2414-6366/3/4/120TropicalMed, Vol. 3, Pages 119: Baseline Mapping of Schistosomiasis and Soil Transmitted Helminthiasis in the Northern and Eastern Health Regions of Gabon, Central Africa: Recommendations for Preventive Chemotherapyhttp://www.mdpi.com/2414-6366/3/4/119
In order to follow the Preventive Chemotherapy (PC) for the transmission control as recommended by WHO, Gabon initiated in 2014 the mapping of Schistosomiasis and Soil Transmitted Helminthiasis (STH). Here, we report the results of the Northern and Eastern health regions, representing a third of the land area and 12% of its total population. All nine departments of the two regions were surveyed and from each, five schools were examined with 50 schoolchildren per school. The parasitological examinations were realized using the filtration method for urine and the Kato-Katz technique for stool samples. Overall 2245 schoolchildren (1116 girls and 1129 boys), mean aged 11.28 &amp;plusmn; 0.04 years, were examined. Combined schistosomiasis and STH affected 1270 (56.6%) with variation between regions, departments, and schools. For schistosomiasis, prevalence were 1.7% across the two regions, with no significant difference (p &amp;gt; 0.05) between the Northern (1.5%) and the Eastern (1.9%). Schistosomiasis is mainly caused by Schistosoma haematobium with the exception of one respective case of S. mansoni and S. guineensis. STH are more common than schistosomiasis, with an overall prevalence of 56.1% significantly different between the Northern (58.1%) and Eastern (53.6%) regions (p = 0.034). Trichuris trichiura is the most abundant infection with a prevalence of 43.7% followed by Ascaris lumbricoides 35.6% and hookworms 1.4%. According to these results, an appropriate PC strategy is given. In particular, because of the low efficacy of a single recommended drug on T. trichiura and hookworms, it is important to include two drugs for the treatment of STH in Gabon, due to the high prevalence and intensities of Trichuris infections.TropicalMed, Vol. 3, Pages 119: Baseline Mapping of Schistosomiasis and Soil Transmitted Helminthiasis in the Northern and Eastern Health Regions of Gabon, Central Africa: Recommendations for Preventive Chemotherapy

In order to follow the Preventive Chemotherapy (PC) for the transmission control as recommended by WHO, Gabon initiated in 2014 the mapping of Schistosomiasis and Soil Transmitted Helminthiasis (STH). Here, we report the results of the Northern and Eastern health regions, representing a third of the land area and 12% of its total population. All nine departments of the two regions were surveyed and from each, five schools were examined with 50 schoolchildren per school. The parasitological examinations were realized using the filtration method for urine and the Kato-Katz technique for stool samples. Overall 2245 schoolchildren (1116 girls and 1129 boys), mean aged 11.28 &amp;plusmn; 0.04 years, were examined. Combined schistosomiasis and STH affected 1270 (56.6%) with variation between regions, departments, and schools. For schistosomiasis, prevalence were 1.7% across the two regions, with no significant difference (p &amp;gt; 0.05) between the Northern (1.5%) and the Eastern (1.9%). Schistosomiasis is mainly caused by Schistosoma haematobium with the exception of one respective case of S. mansoni and S. guineensis. STH are more common than schistosomiasis, with an overall prevalence of 56.1% significantly different between the Northern (58.1%) and Eastern (53.6%) regions (p = 0.034). Trichuris trichiura is the most abundant infection with a prevalence of 43.7% followed by Ascaris lumbricoides 35.6% and hookworms 1.4%. According to these results, an appropriate PC strategy is given. In particular, because of the low efficacy of a single recommended drug on T. trichiura and hookworms, it is important to include two drugs for the treatment of STH in Gabon, due to the high prevalence and intensities of Trichuris infections.

]]>Baseline Mapping of Schistosomiasis and Soil Transmitted Helminthiasis in the Northern and Eastern Health Regions of Gabon, Central Africa: Recommendations for Preventive ChemotherapyRodrigue Mintsa NguemaJacques F. MavoungouKrystina Mengue Me Ngou-MilamaModeste Mabicka MamfoumbiAubin A. KoumbaMariama Sani LamineAbdoulaye DiarraGhislaine Nkone AssekoJean R. MourouMarielle K. Bouyou AkotetHélène MonéGabriel MouahidJulienne Atsamedoi: 10.3390/tropicalmed3040119Tropical Medicine and Infectious Disease2018-11-11Tropical Medicine and Infectious Disease2018-11-1134Article11910.3390/tropicalmed3040119http://www.mdpi.com/2414-6366/3/4/119TropicalMed, Vol. 3, Pages 118: Using Google Trends to Examine the Spatio-Temporal Incidence and Behavioral Patterns of Dengue Disease: A Case Study in Metropolitan Manila, Philippineshttp://www.mdpi.com/2414-6366/3/4/118
Dengue is a major public health concern and an economic burden in the Philippines. Despite the country&amp;rsquo;s improved dengue surveillance, it still suffers from various setbacks and needs to be complemented with alternative approaches. Previous studies have demonstrated the potential of Internet-based surveillance such as Google Dengue Trends (GDT) in supplementing current epidemiological methods for predicting future dengue outbreaks and patterns. With this, our study has two objectives: (1) assess the temporal relationship of weekly GDT and dengue incidence in Metropolitan Manila from 2009&amp;ndash;2014; and (2) examine the health-seeking behavior based on dengue-related search queries of the population. The study collated the population statistics and reported dengue cases in Metropolitan Manila from respective government agencies to calculate the dengue incidence (DI) on a weekly basis for the entire region and annually per city. Data processing of GDT and dengue incidence was performed by conducting an &amp;lsquo;adjustment&amp;rsquo; and scaling procedures, respectively, and further analyzed for correlation and cross-correlation analyses using Pearson&amp;rsquo;s correlation. The relative search volume of the term &amp;lsquo;dengue&amp;rsquo; and top dengue-related search queries in Metropolitan Manila were obtained and organized from the Google Trends platform. Afterwards, a thematic analysis was employed, and word clouds were generated to examine the health behavior of the population. Results showed that weekly temporal GDT pattern are closely similar to the weekly DI pattern in Metropolitan Manila. Further analysis showed that GDT has a moderate and positive association with DI when adjusted or scaled, respectively. Cross-correlation analysis revealed a delayed effect where GDT leads DI by 1&amp;ndash;2 weeks. Thematic analysis of dengue-related search queries indicated 5 categories namely; (a) dengue, (b) sign and symptoms of dengue, (c) treatment and prevention, (d) mosquito, and (e) other diseases. The majority of the search queries were classified in &amp;lsquo;signs and symptoms&amp;rsquo; which indicate the health-seeking behavior of the population towards the disease. Therefore, GDT can be utilized to complement traditional disease surveillance methods combined with other factors that could potentially identify dengue hotspots and help in public health decisions.TropicalMed, Vol. 3, Pages 118: Using Google Trends to Examine the Spatio-Temporal Incidence and Behavioral Patterns of Dengue Disease: A Case Study in Metropolitan Manila, Philippines

Dengue is a major public health concern and an economic burden in the Philippines. Despite the country&amp;rsquo;s improved dengue surveillance, it still suffers from various setbacks and needs to be complemented with alternative approaches. Previous studies have demonstrated the potential of Internet-based surveillance such as Google Dengue Trends (GDT) in supplementing current epidemiological methods for predicting future dengue outbreaks and patterns. With this, our study has two objectives: (1) assess the temporal relationship of weekly GDT and dengue incidence in Metropolitan Manila from 2009&amp;ndash;2014; and (2) examine the health-seeking behavior based on dengue-related search queries of the population. The study collated the population statistics and reported dengue cases in Metropolitan Manila from respective government agencies to calculate the dengue incidence (DI) on a weekly basis for the entire region and annually per city. Data processing of GDT and dengue incidence was performed by conducting an &amp;lsquo;adjustment&amp;rsquo; and scaling procedures, respectively, and further analyzed for correlation and cross-correlation analyses using Pearson&amp;rsquo;s correlation. The relative search volume of the term &amp;lsquo;dengue&amp;rsquo; and top dengue-related search queries in Metropolitan Manila were obtained and organized from the Google Trends platform. Afterwards, a thematic analysis was employed, and word clouds were generated to examine the health behavior of the population. Results showed that weekly temporal GDT pattern are closely similar to the weekly DI pattern in Metropolitan Manila. Further analysis showed that GDT has a moderate and positive association with DI when adjusted or scaled, respectively. Cross-correlation analysis revealed a delayed effect where GDT leads DI by 1&amp;ndash;2 weeks. Thematic analysis of dengue-related search queries indicated 5 categories namely; (a) dengue, (b) sign and symptoms of dengue, (c) treatment and prevention, (d) mosquito, and (e) other diseases. The majority of the search queries were classified in &amp;lsquo;signs and symptoms&amp;rsquo; which indicate the health-seeking behavior of the population towards the disease. Therefore, GDT can be utilized to complement traditional disease surveillance methods combined with other factors that could potentially identify dengue hotspots and help in public health decisions.

]]>Using Google Trends to Examine the Spatio-Temporal Incidence and Behavioral Patterns of Dengue Disease: A Case Study in Metropolitan Manila, PhilippinesHowell T. HoThaddeus M. CarvajalJohn Robert BautistaJayson Dale R. CapistranoKatherine M. ViacrusisLara Fides T. HernandezKozo Watanabedoi: 10.3390/tropicalmed3040118Tropical Medicine and Infectious Disease2018-11-11Tropical Medicine and Infectious Disease2018-11-1134Article11810.3390/tropicalmed3040118http://www.mdpi.com/2414-6366/3/4/118TropicalMed, Vol. 3, Pages 117: Potential Impact of Climate Change on Schistosomiasis: A Global Assessment Attempthttp://www.mdpi.com/2414-6366/3/4/117
Based on an ensemble of global circulation models (GCMs), four representative concentration pathways (RCPs) and several ongoing and planned Coupled Model Intercomparison Projects (CMIPs), the Intergovernmental Panel on Climate Change (IPCC) predicts that global, average temperatures will increase by at least 1.5 &amp;deg;C in the near future and more by the end of the century if greenhouse gases (GHGs) emissions are not genuinely tempered. While the RCPs are indicative of various amounts of GHGs in the atmosphere the CMIPs are designed to improve the workings of the GCMs. We chose RCP4.5 which represented a medium GHG emission increase and CMIP5, the most recently completed CMIP phase. Combining this meteorological model with a biological counterpart model accounted for replication and survival of the snail intermediate host as well as maturation of the parasite stage inside the snail at different ambient temperatures. The potential geographical distribution of the three main schistosome species: Schistosoma japonicum, S. mansoni and S. haematobium was investigated with reference to their different transmission capabilities at the monthly mean temperature, the maximum temperature of the warmest month(s) and the minimum temperature of the coldest month(s). The set of six maps representing the predicted situations in 2021&amp;ndash;2050 and 2071&amp;ndash;2100 for each species mainly showed increased transmission areas for all three species but they also left room for potential shrinkages in certain areas.TropicalMed, Vol. 3, Pages 117: Potential Impact of Climate Change on Schistosomiasis: A Global Assessment Attempt

Based on an ensemble of global circulation models (GCMs), four representative concentration pathways (RCPs) and several ongoing and planned Coupled Model Intercomparison Projects (CMIPs), the Intergovernmental Panel on Climate Change (IPCC) predicts that global, average temperatures will increase by at least 1.5 &amp;deg;C in the near future and more by the end of the century if greenhouse gases (GHGs) emissions are not genuinely tempered. While the RCPs are indicative of various amounts of GHGs in the atmosphere the CMIPs are designed to improve the workings of the GCMs. We chose RCP4.5 which represented a medium GHG emission increase and CMIP5, the most recently completed CMIP phase. Combining this meteorological model with a biological counterpart model accounted for replication and survival of the snail intermediate host as well as maturation of the parasite stage inside the snail at different ambient temperatures. The potential geographical distribution of the three main schistosome species: Schistosoma japonicum, S. mansoni and S. haematobium was investigated with reference to their different transmission capabilities at the monthly mean temperature, the maximum temperature of the warmest month(s) and the minimum temperature of the coldest month(s). The set of six maps representing the predicted situations in 2021&amp;ndash;2050 and 2071&amp;ndash;2100 for each species mainly showed increased transmission areas for all three species but they also left room for potential shrinkages in certain areas.

]]>Potential Impact of Climate Change on Schistosomiasis: A Global Assessment AttemptGuo-Jing YangRobert Bergquistdoi: 10.3390/tropicalmed3040117Tropical Medicine and Infectious Disease2018-11-03Tropical Medicine and Infectious Disease2018-11-0334Article11710.3390/tropicalmed3040117http://www.mdpi.com/2414-6366/3/4/117TropicalMed, Vol. 3, Pages 116: In Situ Diagnosis of Scabies Using a Handheld Digital Microscope in Resource-Poor Settings—A Proof-of-Principle Study in the Amazon Lowland of Colombiahttp://www.mdpi.com/2414-6366/3/4/116
Scabies is a neglected tropical disease associated with important morbidity. The disease occurs worldwide and is particularly common in resource-poor communities in the Global South. A validated technique for the diagnosis of scabies in resource-poor settings does not exist. The objective of the study was to determine the practicability and accuracy of handheld digital microscopy in three indigenous communities in the Amazon lowland of Colombia, where scabies is the most common parasitic skin disease. One-hundred-and-eleven children and adults from three indigenous communities with a presumptive diagnosis of scabies were examined clinically by using a handheld digital microscope placed directly on the skin. The microscopical identification of a mite was verified by an “experienced mother”, a woman who had acquired the skills to diagnose scabies as part of traditional Amerindian medicine. The “experienced mother” removed the parasite with a fine needle and placed it on a flat surface in order to enable its direct examination with the digital microscope. Using digital microscopy, scabies was diagnosed in 24 out of 111 participants and confirmed by the extraction of a Sarcoptes mites from the acarine eminence. A characteristic tunnel (burrow) with or without mite could be clearly identified irrespective of the degree of pigmentation of the skin. Besides, digital microscopy revealed pathological characteristics of scabies hitherto unknown and impossible to be seen in dermoscopy, such as partially or totally obliterated tunnels, tunnels with multiple entry or exit points, circumscribed hyperpigmentation around obliterated tunnels and mites secluded in a nodule. This proof-of-principle study demonstrated the accurate diagnosis of scabies by handheld digital microscopy in patients with pigmented skin and the feasibility of this technique in resource-poor settings.TropicalMed, Vol. 3, Pages 116: In Situ Diagnosis of Scabies Using a Handheld Digital Microscope in Resource-Poor Settings—A Proof-of-Principle Study in the Amazon Lowland of Colombia

Scabies is a neglected tropical disease associated with important morbidity. The disease occurs worldwide and is particularly common in resource-poor communities in the Global South. A validated technique for the diagnosis of scabies in resource-poor settings does not exist. The objective of the study was to determine the practicability and accuracy of handheld digital microscopy in three indigenous communities in the Amazon lowland of Colombia, where scabies is the most common parasitic skin disease. One-hundred-and-eleven children and adults from three indigenous communities with a presumptive diagnosis of scabies were examined clinically by using a handheld digital microscope placed directly on the skin. The microscopical identification of a mite was verified by an “experienced mother”, a woman who had acquired the skills to diagnose scabies as part of traditional Amerindian medicine. The “experienced mother” removed the parasite with a fine needle and placed it on a flat surface in order to enable its direct examination with the digital microscope. Using digital microscopy, scabies was diagnosed in 24 out of 111 participants and confirmed by the extraction of a Sarcoptes mites from the acarine eminence. A characteristic tunnel (burrow) with or without mite could be clearly identified irrespective of the degree of pigmentation of the skin. Besides, digital microscopy revealed pathological characteristics of scabies hitherto unknown and impossible to be seen in dermoscopy, such as partially or totally obliterated tunnels, tunnels with multiple entry or exit points, circumscribed hyperpigmentation around obliterated tunnels and mites secluded in a nodule. This proof-of-principle study demonstrated the accurate diagnosis of scabies by handheld digital microscopy in patients with pigmented skin and the feasibility of this technique in resource-poor settings.

]]>In Situ Diagnosis of Scabies Using a Handheld Digital Microscope in Resource-Poor Settings—A Proof-of-Principle Study in the Amazon Lowland of ColombiaHollman MillerJulian Trujillo-TrujilloHermann Feldmeierdoi: 10.3390/tropicalmed3040116Tropical Medicine and Infectious Disease2018-11-02Tropical Medicine and Infectious Disease2018-11-0234Article11610.3390/tropicalmed3040116http://www.mdpi.com/2414-6366/3/4/116TropicalMed, Vol. 3, Pages 115: Tuberculosis Elimination in the Asia-Pacific Region and the WHO Ethics Guidancehttp://www.mdpi.com/2414-6366/3/4/115
The World Health Organization has produced ethical guidance on implementation of the End TB strategy, which must be considered in local context. The Asia-Pacific Region has important distinctive characteristics relevant to tuberculosis, and engagement with the ethical implications raised is essential. This paper highlights key ethical considerations for the tuberculosis elimination agenda in the Asia-Pacific Regions and suggests that further programmatic work is required to ensure such challenges are addressed in clinical and public health programs.TropicalMed, Vol. 3, Pages 115: Tuberculosis Elimination in the Asia-Pacific Region and the WHO Ethics Guidance

The World Health Organization has produced ethical guidance on implementation of the End TB strategy, which must be considered in local context. The Asia-Pacific Region has important distinctive characteristics relevant to tuberculosis, and engagement with the ethical implications raised is essential. This paper highlights key ethical considerations for the tuberculosis elimination agenda in the Asia-Pacific Regions and suggests that further programmatic work is required to ensure such challenges are addressed in clinical and public health programs.

]]>Tuberculosis Elimination in the Asia-Pacific Region and the WHO Ethics GuidanceJustin T. DenholmDiego S. SilvaErlina BurhanRichard E. Chaissondoi: 10.3390/tropicalmed3040115Tropical Medicine and Infectious Disease2018-10-31Tropical Medicine and Infectious Disease2018-10-3134Commentary11510.3390/tropicalmed3040115http://www.mdpi.com/2414-6366/3/4/115TropicalMed, Vol. 3, Pages 114: Investigation of a Scabies Outbreak in Drought-Affected Areas in Ethiopiahttp://www.mdpi.com/2414-6366/3/4/114
The impact of the severe drought in Ethiopia, attributed to El Ni&amp;ntilde;o weather conditions, has led to high levels of malnutrition that have, in turn, increased the potential for disease outbreaks. In 2015, Ethiopia faced a scabies outbreak in drought-affected areas where there was a shortage of safe water for drinking and personal hygiene. Following a house-to-house census to assess the prevalence of scabies, a detailed study was conducted looking at the disease burden. Following the outbreak report, training was provided on scabies identification and management for zonal and district health officials from administrative districts affected by the drought (nutritional hot-spot woredas). The training was cascaded down to the health extension workers in the affected areas. Screening and management guidelines and protocols were also distributed. House-to-house data collection was undertaken by 450 health extension workers (HEWs) to assess the prevalence of scabies. The HEWs used a simplified reporting tool. Subsequently, data were collected and validated in two zones and six woredas from 474 participants who had been diagnosed with scabies using a standardized questionnaire. This was designed to look at the specificity of the diagnosis of scabies, age distribution, severity, duration of illness, secondary infection and other sociodemographic variables as preparation for mass drug administration (MDA). The HEWs screened 1,125,770 people in the 68 districts in Amhara Region and a total of 379,000 confirmed cases of scabies was identified. The prevalence in the different districts ranged from 2% to 67% and the median was 33.5% [interquartile range (IQR) 19&amp;ndash;48%]. 49% of cases were school-aged children. The detailed study of 474 individuals who were recorded as scabies cases revealed that the specificity of the diagnosis of scabies by the HEWs was 98.3%. The mean duration of illness was 5 months (SD of &amp;plusmn; 2.8). One third of patients were recorded as having severe illness, 75.1% of cases had affected family members, and 30% of affected children were noted to have secondary bacterial infection. Eleven percent of the students had discontinued school due to scabies or/and drought and 85% of these had secondary bacterial infection. These community-based data serve as reliable proxy indicators for community-based burden assessment of the scabies epidemic. This study will also provide a good basis for advocating the use of a community-level clinical diagnostic scheme for scabies using an algorithm with a simple combination of signs and symptoms in resource-poor settings.TropicalMed, Vol. 3, Pages 114: Investigation of a Scabies Outbreak in Drought-Affected Areas in Ethiopia

The impact of the severe drought in Ethiopia, attributed to El Ni&amp;ntilde;o weather conditions, has led to high levels of malnutrition that have, in turn, increased the potential for disease outbreaks. In 2015, Ethiopia faced a scabies outbreak in drought-affected areas where there was a shortage of safe water for drinking and personal hygiene. Following a house-to-house census to assess the prevalence of scabies, a detailed study was conducted looking at the disease burden. Following the outbreak report, training was provided on scabies identification and management for zonal and district health officials from administrative districts affected by the drought (nutritional hot-spot woredas). The training was cascaded down to the health extension workers in the affected areas. Screening and management guidelines and protocols were also distributed. House-to-house data collection was undertaken by 450 health extension workers (HEWs) to assess the prevalence of scabies. The HEWs used a simplified reporting tool. Subsequently, data were collected and validated in two zones and six woredas from 474 participants who had been diagnosed with scabies using a standardized questionnaire. This was designed to look at the specificity of the diagnosis of scabies, age distribution, severity, duration of illness, secondary infection and other sociodemographic variables as preparation for mass drug administration (MDA). The HEWs screened 1,125,770 people in the 68 districts in Amhara Region and a total of 379,000 confirmed cases of scabies was identified. The prevalence in the different districts ranged from 2% to 67% and the median was 33.5% [interquartile range (IQR) 19&amp;ndash;48%]. 49% of cases were school-aged children. The detailed study of 474 individuals who were recorded as scabies cases revealed that the specificity of the diagnosis of scabies by the HEWs was 98.3%. The mean duration of illness was 5 months (SD of &amp;plusmn; 2.8). One third of patients were recorded as having severe illness, 75.1% of cases had affected family members, and 30% of affected children were noted to have secondary bacterial infection. Eleven percent of the students had discontinued school due to scabies or/and drought and 85% of these had secondary bacterial infection. These community-based data serve as reliable proxy indicators for community-based burden assessment of the scabies epidemic. This study will also provide a good basis for advocating the use of a community-level clinical diagnostic scheme for scabies using an algorithm with a simple combination of signs and symptoms in resource-poor settings.

The authors wish to make the following corrections to this paper [...]

]]>Correction: Sando E. et al. Serological Cross-Reactivity among Orientia tsutsugamushi Serotypes but Not with Rickettsia japonica in Japan. Trop. Med. Infect. Dis. 2018, 3, 74.Eiichiro SandoKoya AriyoshiHiromi Fujitadoi: 10.3390/tropicalmed3040113Tropical Medicine and Infectious Disease2018-10-25Tropical Medicine and Infectious Disease2018-10-2534Correction11310.3390/tropicalmed3040113http://www.mdpi.com/2414-6366/3/4/113TropicalMed, Vol. 3, Pages 112: Trends in Tuberculosis Incidence in the Australian-Born in Victoria: Opportunities and Challenges to Eliminationhttp://www.mdpi.com/2414-6366/3/4/112
Australia is a low tuberculosis incidence country. In the setting of increasing migration, we aimed to investigate the epidemiology and trends of tuberculosis in the Australian-born population in the state of Victoria between 1992 and 2017. We performed a retrospective descriptive analysis of demographic, clinical and outcome data extracted from a centralized notifiable disease database. The mean incidence of tuberculosis was 1.19 cases per 100,000 population per year with a small but significant reduction of 0.98% per year. The median age of cases decreased from 67.5 years in 1994 to 17 years in 2017. Among 0&amp;ndash;14 year-olds, there was an increase from 0.13 cases per 100,000 population in 1996 to 2.15 per 100,000 population in 2017. Data for risk factors were available from 2002 onwards. The most common risk factor in the 0&amp;ndash;14 year age group was a household contact with tuberculosis (85.1%), followed by having a parent from a high tuberculosis incidence country (70.2%). We found the rate of tuberculosis in the Australian-born population in Victoria is low. However, there has been an increase in incidence in children, particularly among those with links to countries with high tuberculosis incidence. This could threaten progress towards tuberculosis elimination in Australia.TropicalMed, Vol. 3, Pages 112: Trends in Tuberculosis Incidence in the Australian-Born in Victoria: Opportunities and Challenges to Elimination

Australia is a low tuberculosis incidence country. In the setting of increasing migration, we aimed to investigate the epidemiology and trends of tuberculosis in the Australian-born population in the state of Victoria between 1992 and 2017. We performed a retrospective descriptive analysis of demographic, clinical and outcome data extracted from a centralized notifiable disease database. The mean incidence of tuberculosis was 1.19 cases per 100,000 population per year with a small but significant reduction of 0.98% per year. The median age of cases decreased from 67.5 years in 1994 to 17 years in 2017. Among 0&amp;ndash;14 year-olds, there was an increase from 0.13 cases per 100,000 population in 1996 to 2.15 per 100,000 population in 2017. Data for risk factors were available from 2002 onwards. The most common risk factor in the 0&amp;ndash;14 year age group was a household contact with tuberculosis (85.1%), followed by having a parent from a high tuberculosis incidence country (70.2%). We found the rate of tuberculosis in the Australian-born population in Victoria is low. However, there has been an increase in incidence in children, particularly among those with links to countries with high tuberculosis incidence. This could threaten progress towards tuberculosis elimination in Australia.

]]>Trends in Tuberculosis Incidence in the Australian-Born in Victoria: Opportunities and Challenges to EliminationOuli XieEe Laine TayJustin Denholmdoi: 10.3390/tropicalmed3040112Tropical Medicine and Infectious Disease2018-10-11Tropical Medicine and Infectious Disease2018-10-1134Article11210.3390/tropicalmed3040112http://www.mdpi.com/2414-6366/3/4/112TropicalMed, Vol. 3, Pages 111: Low Praziquantel Treatment Coverage for Schistosoma mansoni in Mayuge District, Uganda, Due to the Absence of Treatment Opportunities, Rather Than Systematic Non-Compliancehttp://www.mdpi.com/2414-6366/3/4/111
The World Health Organization (WHO) recommends praziquantel mass drug administration (MDA) to control schistosomiasis in endemic regions. We aimed to quantify recent and lifetime praziquantel coverage, and reasons for non-treatment, at an individual level to guide policy recommendations to help Uganda reach WHO goals. Cross-sectional household surveys (n = 681) encompassing 3208 individuals (adults and children) were conducted in 2017 in Bugoto A and B, Mayuge District, Uganda. Participants were asked if they had received praziquantel during the recent MDA (October 2016) and whether they had ever received praziquantel in their lifetime. A multivariate logistic regression analysis with socio-economic and individual characteristics as covariates was used to determine factors associated with praziquantel uptake. In the MDA eligible population (&amp;ge;5 years of age), the most recent MDA coverage was 48.8%. Across individuals&amp;rsquo; lifetimes, 31.8% of eligible and 49.5% of the entire population reported having never taken praziquantel. Factors that improved individuals&amp;rsquo; odds of taking praziquantel included school enrolment, residence in Bugoto B and increasing years of village-residency. Not being offered (49.2%) and being away during treatment (21.4%) were the most frequent reasons for not taking the 2016 praziquantel MDA. Contrary to expectations, chronically-untreated individuals were rarely systematic non-compliers, but more commonly not offered treatment.TropicalMed, Vol. 3, Pages 111: Low Praziquantel Treatment Coverage for Schistosoma mansoni in Mayuge District, Uganda, Due to the Absence of Treatment Opportunities, Rather Than Systematic Non-Compliance

The World Health Organization (WHO) recommends praziquantel mass drug administration (MDA) to control schistosomiasis in endemic regions. We aimed to quantify recent and lifetime praziquantel coverage, and reasons for non-treatment, at an individual level to guide policy recommendations to help Uganda reach WHO goals. Cross-sectional household surveys (n = 681) encompassing 3208 individuals (adults and children) were conducted in 2017 in Bugoto A and B, Mayuge District, Uganda. Participants were asked if they had received praziquantel during the recent MDA (October 2016) and whether they had ever received praziquantel in their lifetime. A multivariate logistic regression analysis with socio-economic and individual characteristics as covariates was used to determine factors associated with praziquantel uptake. In the MDA eligible population (&amp;ge;5 years of age), the most recent MDA coverage was 48.8%. Across individuals&amp;rsquo; lifetimes, 31.8% of eligible and 49.5% of the entire population reported having never taken praziquantel. Factors that improved individuals&amp;rsquo; odds of taking praziquantel included school enrolment, residence in Bugoto B and increasing years of village-residency. Not being offered (49.2%) and being away during treatment (21.4%) were the most frequent reasons for not taking the 2016 praziquantel MDA. Contrary to expectations, chronically-untreated individuals were rarely systematic non-compliers, but more commonly not offered treatment.

]]>Low Praziquantel Treatment Coverage for Schistosoma mansoni in Mayuge District, Uganda, Due to the Absence of Treatment Opportunities, Rather Than Systematic Non-ComplianceMoses AdrikoChristina L. FaustLauren V. CarruthersArinaitwe MosesEdridah M. TukahebwaPoppy H. L. Lambertondoi: 10.3390/tropicalmed3040111Tropical Medicine and Infectious Disease2018-10-08Tropical Medicine and Infectious Disease2018-10-0834Article11110.3390/tropicalmed3040111http://www.mdpi.com/2414-6366/3/4/111TropicalMed, Vol. 3, Pages 110: Zoonotic Helminth Diseases in Dogs and Dingoes Utilising Shared Resources in an Australian Aboriginal Communityhttp://www.mdpi.com/2414-6366/3/4/110
The impacts of free-roaming canids (domestic and wild) on public health have long been a concern in Australian Indigenous communities. We investigated the prevalence of zoonotic helminth diseases in dogs and sympatric dingoes, and used radio telemetry to measure their spatial overlap, in an Aboriginal community in the Wet Tropics of Australia. Samples collected from dingoes and dogs showed high levels of infection with the zoonotic hookworm, Ancylostoma caninum. Dingoes were also positive for A. ceylanicum infection (11.4%), but dogs were infection free. Whipworm, Trichuris vulpis, infection was far more prevalent in necropsies of domestic dogs (78.6%) than dingoes (3.7%). Dogs were free from Dirofilaria immitis infection, while dingoes recorded 46.2% infection. Eleven dingoes and seven free-roaming domestic dogs were fitted with Global Positioning System collars and tracked over an extended period. Dingo home-ranges almost completely overlapped those of the domestic dogs. However, dingoes and dogs did not utilise the same area at the same time, and dogs may have avoided dingoes. This spatial overlap in resource use presents an opportunity for the indirect spill-over and spill-back of parasites between dogs and dingoes. Tracking and camera traps showed that the community rubbish tip and animal carcasses were areas of concentrated activity for dogs and dingoes.TropicalMed, Vol. 3, Pages 110: Zoonotic Helminth Diseases in Dogs and Dingoes Utilising Shared Resources in an Australian Aboriginal Community

The impacts of free-roaming canids (domestic and wild) on public health have long been a concern in Australian Indigenous communities. We investigated the prevalence of zoonotic helminth diseases in dogs and sympatric dingoes, and used radio telemetry to measure their spatial overlap, in an Aboriginal community in the Wet Tropics of Australia. Samples collected from dingoes and dogs showed high levels of infection with the zoonotic hookworm, Ancylostoma caninum. Dingoes were also positive for A. ceylanicum infection (11.4%), but dogs were infection free. Whipworm, Trichuris vulpis, infection was far more prevalent in necropsies of domestic dogs (78.6%) than dingoes (3.7%). Dogs were free from Dirofilaria immitis infection, while dingoes recorded 46.2% infection. Eleven dingoes and seven free-roaming domestic dogs were fitted with Global Positioning System collars and tracked over an extended period. Dingo home-ranges almost completely overlapped those of the domestic dogs. However, dingoes and dogs did not utilise the same area at the same time, and dogs may have avoided dingoes. This spatial overlap in resource use presents an opportunity for the indirect spill-over and spill-back of parasites between dogs and dingoes. Tracking and camera traps showed that the community rubbish tip and animal carcasses were areas of concentrated activity for dogs and dingoes.

]]>Zoonotic Helminth Diseases in Dogs and Dingoes Utilising Shared Resources in an Australian Aboriginal CommunityFelicity A. SmoutLee F. SkerrattChristopher N. JohnsonJames R. A. ButlerBradley C. Congdondoi: 10.3390/tropicalmed3040110Tropical Medicine and Infectious Disease2018-10-08Tropical Medicine and Infectious Disease2018-10-0834Article11010.3390/tropicalmed3040110http://www.mdpi.com/2414-6366/3/4/110TropicalMed, Vol. 3, Pages 109: Assessment of a Rabies Virus Rapid Diagnostic Test for the Detection of Australian Bat Lyssavirushttp://www.mdpi.com/2414-6366/3/4/109
Australian bat lyssavirus (ABLV) is closely related to the classical rabies virus and has been associated with three human fatalities and two equine fatalities in Australia. ABLV infection in humans causes encephalomyelitis, resulting in fatal disease, but has no effective therapy. The virus is maintained in enzootic circulation within fruit bats (Pteropid spp.) and at least one insectivorous bat variety (Saccolaimus flaviventris). Most frequently, laboratory testing is conducted on pteropodid bat brains, either following a potential human exposure through bites, scratches and other direct contacts with bats, or as opportunistic assessment of sick or dead bats. The level of medical intervention and post-exposure prophylaxis is largely determined on laboratory testing for antigen/virus as the demonstrable infection status of the in-contact bat. This study evaluates the comparative diagnostic performance of a lateral flow test, Anigen Rabies Ag detection rapid test (RDT), in pteropodid variant of ABLV-infected bat brain tissues. The RDT demonstrated 100% agreement with the reference standard fluorescent antibody test on 43 clinical samples suggesting a potential application in rapid diagnosis of pteropodid variant of ABLV infection. A weighted Kappa value of 0.95 confirmed a high level of agreement between both tests.TropicalMed, Vol. 3, Pages 109: Assessment of a Rabies Virus Rapid Diagnostic Test for the Detection of Australian Bat Lyssavirus

Australian bat lyssavirus (ABLV) is closely related to the classical rabies virus and has been associated with three human fatalities and two equine fatalities in Australia. ABLV infection in humans causes encephalomyelitis, resulting in fatal disease, but has no effective therapy. The virus is maintained in enzootic circulation within fruit bats (Pteropid spp.) and at least one insectivorous bat variety (Saccolaimus flaviventris). Most frequently, laboratory testing is conducted on pteropodid bat brains, either following a potential human exposure through bites, scratches and other direct contacts with bats, or as opportunistic assessment of sick or dead bats. The level of medical intervention and post-exposure prophylaxis is largely determined on laboratory testing for antigen/virus as the demonstrable infection status of the in-contact bat. This study evaluates the comparative diagnostic performance of a lateral flow test, Anigen Rabies Ag detection rapid test (RDT), in pteropodid variant of ABLV-infected bat brain tissues. The RDT demonstrated 100% agreement with the reference standard fluorescent antibody test on 43 clinical samples suggesting a potential application in rapid diagnosis of pteropodid variant of ABLV infection. A weighted Kappa value of 0.95 confirmed a high level of agreement between both tests.

]]>Assessment of a Rabies Virus Rapid Diagnostic Test for the Detection of Australian Bat LyssavirusAndrea CertomaRoss A. LuntWilna VoslooIna SmithAxel CollingDavid T. WilliamsThao TranStuart D. Blackselldoi: 10.3390/tropicalmed3040109Tropical Medicine and Infectious Disease2018-10-04Tropical Medicine and Infectious Disease2018-10-0434Article10910.3390/tropicalmed3040109http://www.mdpi.com/2414-6366/3/4/109TropicalMed, Vol. 3, Pages 108: “Farewell to the God of Plague”: The Importance of Political Commitment Towards the Elimination of Schistosomiasishttp://www.mdpi.com/2414-6366/3/4/108
Schistosomiasis control in China has always been conducted with strong political leadership and support at the highest level of government [1] [...]TropicalMed, Vol. 3, Pages 108: “Farewell to the God of Plague”: The Importance of Political Commitment Towards the Elimination of Schistosomiasis

Schistosomiasis control in China has always been conducted with strong political leadership and support at the highest level of government [1] [...]

]]>“Farewell to the God of Plague”: The Importance of Political Commitment Towards the Elimination of SchistosomiasisJin ChenJing XuRobert BergquistShi-Zhu LiXiao-Nong Zhoudoi: 10.3390/tropicalmed3040108Tropical Medicine and Infectious Disease2018-10-03Tropical Medicine and Infectious Disease2018-10-0334Editorial10810.3390/tropicalmed3040108http://www.mdpi.com/2414-6366/3/4/108TropicalMed, Vol. 3, Pages 107: Polymerase Chain Reaction (PCR) as a Potential Point of Care Laboratory Test for Leprosy Diagnosis—A Systematic Reviewhttp://www.mdpi.com/2414-6366/3/4/107
Leprosy is an infectious disease caused by Mycobacterium leprae and mainly affects skin, peripheral nerves, and eyes. Suitable tools for providing bacteriological evidence of leprosy are needed for early case detection and appropriate therapeutic management. Ideally these tools are applicable at all health care levels for the effective control of leprosy. This paper presents a systematic review analysis in order to investigate the performance of polymerase chain reaction (PCR) vis-&amp;agrave;-vis slit skin smears (SSS) in various clinical settings and its potential usefulness as a routine lab test for leprosy diagnosis. Records of published journal articles were identified through PubMed database search. Twenty-seven articles were included for the analysis. The evidence from this review analysis suggests that PCR on skin biopsy is the ideal diagnostic test. Nevertheless, PCR on SSS samples also seems to be useful with its practical value for application, even at primary care levels. The review findings also indicated the necessity for improving the sensitivity of PCR and further research on specificity in ruling out other clinical conditions that may mimic leprosy. The M. leprae-specific repetitive element (RLEP) was the most frequently-used marker although its variable performance across the clinical sites and samples are a matter of concern. Undertaking further research studies with large sample numbers and uniform protocols studied simultaneously across multiple clinical sites is recommended to address these issues.TropicalMed, Vol. 3, Pages 107: Polymerase Chain Reaction (PCR) as a Potential Point of Care Laboratory Test for Leprosy Diagnosis—A Systematic Review

Leprosy is an infectious disease caused by Mycobacterium leprae and mainly affects skin, peripheral nerves, and eyes. Suitable tools for providing bacteriological evidence of leprosy are needed for early case detection and appropriate therapeutic management. Ideally these tools are applicable at all health care levels for the effective control of leprosy. This paper presents a systematic review analysis in order to investigate the performance of polymerase chain reaction (PCR) vis-&amp;agrave;-vis slit skin smears (SSS) in various clinical settings and its potential usefulness as a routine lab test for leprosy diagnosis. Records of published journal articles were identified through PubMed database search. Twenty-seven articles were included for the analysis. The evidence from this review analysis suggests that PCR on skin biopsy is the ideal diagnostic test. Nevertheless, PCR on SSS samples also seems to be useful with its practical value for application, even at primary care levels. The review findings also indicated the necessity for improving the sensitivity of PCR and further research on specificity in ruling out other clinical conditions that may mimic leprosy. The M. leprae-specific repetitive element (RLEP) was the most frequently-used marker although its variable performance across the clinical sites and samples are a matter of concern. Undertaking further research studies with large sample numbers and uniform protocols studied simultaneously across multiple clinical sites is recommended to address these issues.

]]>Polymerase Chain Reaction (PCR) as a Potential Point of Care Laboratory Test for Leprosy Diagnosis—A Systematic ReviewSushma TatipallyAparna SrikantamSanjay Kasettydoi: 10.3390/tropicalmed3040107Tropical Medicine and Infectious Disease2018-10-01Tropical Medicine and Infectious Disease2018-10-0134Review10710.3390/tropicalmed3040107http://www.mdpi.com/2414-6366/3/4/107TropicalMed, Vol. 3, Pages 106: Control of Communicable Diseases in Human and in Animal Populations: 70th Anniversary of the Year of the Birth of Professor Rick Speare (2 August 1947–5 June 2016)http://www.mdpi.com/2414-6366/3/4/106
n/aTropicalMed, Vol. 3, Pages 106: Control of Communicable Diseases in Human and in Animal Populations: 70th Anniversary of the Year of the Birth of Professor Rick Speare (2 August 1947–5 June 2016)

]]>Control of Communicable Diseases in Human and in Animal Populations: 70th Anniversary of the Year of the Birth of Professor Rick Speare (2 August 1947–5 June 2016)Jorg Heukelbachdoi: 10.3390/tropicalmed3040106Tropical Medicine and Infectious Disease2018-09-28Tropical Medicine and Infectious Disease2018-09-2834Editorial10610.3390/tropicalmed3040106http://www.mdpi.com/2414-6366/3/4/106TropicalMed, Vol. 3, Pages 105: Low Microfilaremia Levels in Three Districts in Coastal Ghana with at Least 16 Years of Mass Drug Administration and Persistent Transmission of Lymphatic Filariasishttp://www.mdpi.com/2414-6366/3/4/105
Ghana has been implementing mass drug administration (MDA) of ivermectin and albendazole for the elimination of lymphatic filariasis (LF) since the year 2000, as part of the Global Programme to Eliminate Lymphatic Filariasis (GPELF). It was estimated that 5&amp;ndash;6 years of treatment would be sufficient to eliminate the disease. Tremendous progress has been made over the years, and treatment has stopped in many disease endemic districts. However, despite the successful implementation of MDA, there are districts with persistent transmission. In this study we assessed the epidemiology of LF in three adjoining districts that have received at least 16 years of MDA. The assessments were undertaken one year after the last MDA. 1234 adults and 182 children below the age of 10 years were assessed. The overall prevalence of circulating filarial antigen in the study participants was 8.3% (95% CI: 6.9&amp;ndash;9.9), with an estimated microfilaria prevalence of 1.2%. The microfilarial intensity in positive individuals ranged from 1 to 57 microfilariae/mL of blood. Higher antigen prevalence was detected in males (13.0%; 95% CI: 10.3&amp;ndash;16.2) compared to females (5.5%; 95% CI: 4.1&amp;ndash;7.2). The presence of infection was also highest in individuals involved in outdoor commercial activities, with the risks of infection being four- to five-fold higher among farmers, fishermen, drivers and artisans, compared to all other occupations. Using bednets or participating in MDA did not significantly influence the risk of infection. No children below the age of 10 years were found with infection. Detection of Wb123 antibodies for current infections indicated a prevalence of 14.4% (95% CI: 8.1&amp;ndash;23.0) in antigen-positive individuals above 10 years of age. No antibodies were detected in children 10 years or below. Assessment of infection within the An. gambiae vectors of LF indicated an infection rate of 0.9% (95% CI: 0.3&amp;ndash;2.1) and infectivity rate of 0.5% (95% CI: 0.1&amp;ndash;1.6). These results indicate low-level transmission within the districts, and suggest that it will require targeted interventions in order to eliminate the infection.TropicalMed, Vol. 3, Pages 105: Low Microfilaremia Levels in Three Districts in Coastal Ghana with at Least 16 Years of Mass Drug Administration and Persistent Transmission of Lymphatic Filariasis

Ghana has been implementing mass drug administration (MDA) of ivermectin and albendazole for the elimination of lymphatic filariasis (LF) since the year 2000, as part of the Global Programme to Eliminate Lymphatic Filariasis (GPELF). It was estimated that 5&amp;ndash;6 years of treatment would be sufficient to eliminate the disease. Tremendous progress has been made over the years, and treatment has stopped in many disease endemic districts. However, despite the successful implementation of MDA, there are districts with persistent transmission. In this study we assessed the epidemiology of LF in three adjoining districts that have received at least 16 years of MDA. The assessments were undertaken one year after the last MDA. 1234 adults and 182 children below the age of 10 years were assessed. The overall prevalence of circulating filarial antigen in the study participants was 8.3% (95% CI: 6.9&amp;ndash;9.9), with an estimated microfilaria prevalence of 1.2%. The microfilarial intensity in positive individuals ranged from 1 to 57 microfilariae/mL of blood. Higher antigen prevalence was detected in males (13.0%; 95% CI: 10.3&amp;ndash;16.2) compared to females (5.5%; 95% CI: 4.1&amp;ndash;7.2). The presence of infection was also highest in individuals involved in outdoor commercial activities, with the risks of infection being four- to five-fold higher among farmers, fishermen, drivers and artisans, compared to all other occupations. Using bednets or participating in MDA did not significantly influence the risk of infection. No children below the age of 10 years were found with infection. Detection of Wb123 antibodies for current infections indicated a prevalence of 14.4% (95% CI: 8.1&amp;ndash;23.0) in antigen-positive individuals above 10 years of age. No antibodies were detected in children 10 years or below. Assessment of infection within the An. gambiae vectors of LF indicated an infection rate of 0.9% (95% CI: 0.3&amp;ndash;2.1) and infectivity rate of 0.5% (95% CI: 0.1&amp;ndash;1.6). These results indicate low-level transmission within the districts, and suggest that it will require targeted interventions in order to eliminate the infection.

]]>Low Microfilaremia Levels in Three Districts in Coastal Ghana with at Least 16 Years of Mass Drug Administration and Persistent Transmission of Lymphatic FilariasisDziedzom K. De SouzaJoseph OtchereCollins S. AhorluSusan Adu-AmankwahIrene A. LarbiEdward DumashieFrances A. McCarthySandra A. KingSamson OtooDickson OsabuteyJoseph H. N. OseiKojo M. SedzroOdame AsieduSamuel K. DadzieIrene AyiBenjamin MarfoNana-Kwadwo BiritwumDaniel A. Boakyedoi: 10.3390/tropicalmed3040105Tropical Medicine and Infectious Disease2018-09-26Tropical Medicine and Infectious Disease2018-09-2634Article10510.3390/tropicalmed3040105http://www.mdpi.com/2414-6366/3/4/105TropicalMed, Vol. 3, Pages 104: Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literaturehttp://www.mdpi.com/2414-6366/3/3/104
The black mamba (Dendroaspis polylepis) ranks consistently as one of the most revered snakes in sub-Saharan Africa. It has potent neurotoxic venom, and envenomation results in rapid onset and severe clinical manifestations. This report describes the clinical course and reversal of effects of black mamba envenomation in a 13-year-old boy in the Jimba area of Malindi. The victim presented to Watamu Hospital, a low resource health facility with labored breathing, frothing at the mouth, severe ptosis and pupils non-responsive to light. His blood pressure was unrecordable, heart rate was 100 beats per minute but thready, his temperature was 35.5 &amp;deg;C, and oxygen saturation was 83%. Management involved suction to clear salivary secretions, several hours of mechanical ventilation via ambu-bagging, oxygen saturation monitoring, and the use of South African Vaccine Producers (SAVP) polyvalent antivenom. Subcutaneous adrenaline was used to stave off anaphylaxis. The victim went into cardiac arrest on two occasions and chest compressions lasting 3&amp;ndash;5 min was used to complement artificial ventilation. Hemodynamic instability was corrected using IV infusion of ringers lactate and normal saline (three liters over 24 h). Adequate mechanical ventilation and the use of specific antivenom remain key in the management of black mamba envenomation.TropicalMed, Vol. 3, Pages 104: Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the Literature

The black mamba (Dendroaspis polylepis) ranks consistently as one of the most revered snakes in sub-Saharan Africa. It has potent neurotoxic venom, and envenomation results in rapid onset and severe clinical manifestations. This report describes the clinical course and reversal of effects of black mamba envenomation in a 13-year-old boy in the Jimba area of Malindi. The victim presented to Watamu Hospital, a low resource health facility with labored breathing, frothing at the mouth, severe ptosis and pupils non-responsive to light. His blood pressure was unrecordable, heart rate was 100 beats per minute but thready, his temperature was 35.5 &amp;deg;C, and oxygen saturation was 83%. Management involved suction to clear salivary secretions, several hours of mechanical ventilation via ambu-bagging, oxygen saturation monitoring, and the use of South African Vaccine Producers (SAVP) polyvalent antivenom. Subcutaneous adrenaline was used to stave off anaphylaxis. The victim went into cardiac arrest on two occasions and chest compressions lasting 3&amp;ndash;5 min was used to complement artificial ventilation. Hemodynamic instability was corrected using IV infusion of ringers lactate and normal saline (three liters over 24 h). Adequate mechanical ventilation and the use of specific antivenom remain key in the management of black mamba envenomation.

]]>Revered but Poorly Understood: A Case Report of Dendroaspis polylepis (Black Mamba) Envenomation in Watamu, Malindi Kenya, and a Review of the LiteratureValentine Eugene EruluMitchel Otieno OkumuFrancis Okumu OcholaJoseph Kangangi Gikunjudoi: 10.3390/tropicalmed3030104Tropical Medicine and Infectious Disease2018-09-19Tropical Medicine and Infectious Disease2018-09-1933Case Report10410.3390/tropicalmed3030104http://www.mdpi.com/2414-6366/3/3/104TropicalMed, Vol. 3, Pages 103: Hospitalizations and Deaths Associated with Diarrhea and Respiratory Diseases among Children Aged 0–5 Years in a Referral Hospital of Mauritaniahttp://www.mdpi.com/2414-6366/3/3/103
Diarrhea and respiratory diseases are the leading causes of morbidity and mortality among &amp;lt;5-year-olds worldwide, but systematic data are not available from Mauritania. We conducted a hospital-based retrospective study. Data on admissions to Mauritania&amp;rsquo;s National Referral Hospital (the main pediatric referral center in the country), due to diarrhea and respiratory diseases, during 2011&amp;ndash;2014, were analyzed. A total of 3695 children &amp;lt;5 years were hospitalized during this period; 665 (18.0%) due to respiratory diseases, and 829 (22.4%) due to diarrhea. Case fatality rates in the respiratory diseases and diarrhea groups were 18.0% (120/665) and 14.1% (117/829), respectively. The highest frequency of deaths due to diarrhea occurred in the age group 2&amp;ndash;5 years (16/76; 21.0%), and due to respiratory diseases in the age group 6&amp;ndash;12 months (32/141; 22.6%). We conclude that case fatality rates caused by respiratory diseases and diarrhea are extremely high in children hospitalized at the National Referral Hospital. These data call for intensified efforts to reduce deaths among hospitalized Mauritanian children, and also for integrated control measures to prevent and reduce the burden of both diseases. Additional studies are needed to show the effectiveness of the introduction of vaccination programs for pneumococcal diseases and rotavirus infection in the child population, which were launched in November 2013 and December 2014, respectively.TropicalMed, Vol. 3, Pages 103: Hospitalizations and Deaths Associated with Diarrhea and Respiratory Diseases among Children Aged 0–5 Years in a Referral Hospital of Mauritania

Diarrhea and respiratory diseases are the leading causes of morbidity and mortality among &amp;lt;5-year-olds worldwide, but systematic data are not available from Mauritania. We conducted a hospital-based retrospective study. Data on admissions to Mauritania&amp;rsquo;s National Referral Hospital (the main pediatric referral center in the country), due to diarrhea and respiratory diseases, during 2011&amp;ndash;2014, were analyzed. A total of 3695 children &amp;lt;5 years were hospitalized during this period; 665 (18.0%) due to respiratory diseases, and 829 (22.4%) due to diarrhea. Case fatality rates in the respiratory diseases and diarrhea groups were 18.0% (120/665) and 14.1% (117/829), respectively. The highest frequency of deaths due to diarrhea occurred in the age group 2&amp;ndash;5 years (16/76; 21.0%), and due to respiratory diseases in the age group 6&amp;ndash;12 months (32/141; 22.6%). We conclude that case fatality rates caused by respiratory diseases and diarrhea are extremely high in children hospitalized at the National Referral Hospital. These data call for intensified efforts to reduce deaths among hospitalized Mauritanian children, and also for integrated control measures to prevent and reduce the burden of both diseases. Additional studies are needed to show the effectiveness of the introduction of vaccination programs for pneumococcal diseases and rotavirus infection in the child population, which were launched in November 2013 and December 2014, respectively.

]]>Hospitalizations and Deaths Associated with Diarrhea and Respiratory Diseases among Children Aged 0–5 Years in a Referral Hospital of MauritaniaMohamed Lemine Cheikh Brahim AhmedAbdellahi WeddihMohammed BenhafidMohamed Abdellahi BollahiMariem SidattKhattry MakhallaAli H. MokdadJorg HeukelbachAbdelkarim Filali-Maltoufdoi: 10.3390/tropicalmed3030103Tropical Medicine and Infectious Disease2018-09-17Tropical Medicine and Infectious Disease2018-09-1733Article10310.3390/tropicalmed3030103http://www.mdpi.com/2414-6366/3/3/103TropicalMed, Vol. 3, Pages 102: The Development of a Mobile Application to Support Peripheral Health Workers to Diagnose and Treat People with Skin Diseases in Resource-Poor Settingshttp://www.mdpi.com/2414-6366/3/3/102
The high prevalence of skin diseases in resource-poor settings, where health workers with sufficient knowledge of skin diseases are scarce, calls for innovative measures. Timely diagnosis and treatment of skin diseases, especially neglected tropical diseases (NTDs) that manifest with skin lesions, such as leprosy, is crucial to prevent disabilities as well as psychological and socioeconomic problems. Innovative technological methods like telemedicine and mobile health (mHealth) can help to bridge the gap between the burden of skin diseases and the lack of capable staff in resource-poor settings by bringing essential health services from central level closer to peripheral levels. Netherlands Leprosy Relief (NLR) has developed a mobile phone application called the &amp;lsquo;SkinApp&amp;rsquo;, which aims to support peripheral health workers to recognize the early signs and symptoms of skin diseases, including skin NTDs, and to start treatment promptly or refer for more advanced diagnostic testing or disease management when needed. Further research is needed to determine how greatly mHealth in general and the SkinApp in particular can contribute to improved health outcomes, efficiency, and cost-effectiveness.TropicalMed, Vol. 3, Pages 102: The Development of a Mobile Application to Support Peripheral Health Workers to Diagnose and Treat People with Skin Diseases in Resource-Poor Settings

The high prevalence of skin diseases in resource-poor settings, where health workers with sufficient knowledge of skin diseases are scarce, calls for innovative measures. Timely diagnosis and treatment of skin diseases, especially neglected tropical diseases (NTDs) that manifest with skin lesions, such as leprosy, is crucial to prevent disabilities as well as psychological and socioeconomic problems. Innovative technological methods like telemedicine and mobile health (mHealth) can help to bridge the gap between the burden of skin diseases and the lack of capable staff in resource-poor settings by bringing essential health services from central level closer to peripheral levels. Netherlands Leprosy Relief (NLR) has developed a mobile phone application called the &amp;lsquo;SkinApp&amp;rsquo;, which aims to support peripheral health workers to recognize the early signs and symptoms of skin diseases, including skin NTDs, and to start treatment promptly or refer for more advanced diagnostic testing or disease management when needed. Further research is needed to determine how greatly mHealth in general and the SkinApp in particular can contribute to improved health outcomes, efficiency, and cost-effectiveness.

]]>The Development of a Mobile Application to Support Peripheral Health Workers to Diagnose and Treat People with Skin Diseases in Resource-Poor SettingsLiesbeth F. MierasAnna T. TaalErik B. PostAlcino G. Z. NdeveColette L. M. Van Heesdoi: 10.3390/tropicalmed3030102Tropical Medicine and Infectious Disease2018-09-15Tropical Medicine and Infectious Disease2018-09-1533Communication10210.3390/tropicalmed3030102http://www.mdpi.com/2414-6366/3/3/102TropicalMed, Vol. 3, Pages 101: The Skin—A Common Pathway for Integrating Diagnosis and Management of NTDshttp://www.mdpi.com/2414-6366/3/3/101
Many of the neglected tropical diseases (NTDs) have major skin manifestations. These skin-related NTDs or &amp;lsquo;skin NTDs&amp;rsquo; cause significant morbidity and economic hardship in some of the poorest communities worldwide. We draw attention to the collective burden of skin disease and suggest that the skin be used as a platform for the integration of control activities for NTDs. The opportunities for integration are numerous, ranging from diagnosis and disease mapping to mass drug administration and morbidity management. The dermatology community has an important role to play, and will be expected to support research and control activities globally.TropicalMed, Vol. 3, Pages 101: The Skin—A Common Pathway for Integrating Diagnosis and Management of NTDs

Many of the neglected tropical diseases (NTDs) have major skin manifestations. These skin-related NTDs or &amp;lsquo;skin NTDs&amp;rsquo; cause significant morbidity and economic hardship in some of the poorest communities worldwide. We draw attention to the collective burden of skin disease and suggest that the skin be used as a platform for the integration of control activities for NTDs. The opportunities for integration are numerous, ranging from diagnosis and disease mapping to mass drug administration and morbidity management. The dermatology community has an important role to play, and will be expected to support research and control activities globally.

]]>The Skin—A Common Pathway for Integrating Diagnosis and Management of NTDsDavid John ChandlerLucinda Claire Fullerdoi: 10.3390/tropicalmed3030101Tropical Medicine and Infectious Disease2018-09-10Tropical Medicine and Infectious Disease2018-09-1033Review10110.3390/tropicalmed3030101http://www.mdpi.com/2414-6366/3/3/101TropicalMed, Vol. 3, Pages 100: Young Adults in Endemic Areas: An Untreated Group in Need of School-Based Preventive Chemotherapy for Schistosomiasis Control and Eliminationhttp://www.mdpi.com/2414-6366/3/3/100
Parasitologic surveys of young adults in college and university settings are not commonly done, even in areas known to be endemic for schistosomiasis and soil-transmitted helminths. We have done a survey of 291 students and staff at the Kisumu National Polytechnic in Kisumu, Kenya, using the stool microscopy Kato-Katz (KK) method and the urine point-of-care circulating cathodic antigen (POC-CCA) test. Based on three stools/two KK slides each, in the 208 participants for whom three consecutive stools were obtained, Schistosoma mansoni prevalence was 17.8%. When all 291 individuals were analyzed based on the first stool, as done by the national neglected tropical disease (NTD) program, and one urine POC-CCA assay (n = 276), the prevalence was 13.7% by KK and 23.2% by POC-CCA. Based on three stools, 2.5% of 208 participants had heavy S. mansoni infections (&amp;ge;400 eggs/gram feces), with heavy S. mansoni infections making up 13.5% of the S. mansoni cases. The prevalence of the soil-transmitted helminths (STH: Ascaris lumbricoides, Trichuris trichiura and hookworm) by three stools was 1.4%, 3.1%, and 4.1%, respectively, and by the first stool was 1.4%, 2.4% and 1.4%, respectively. This prevalence and intensity of infection with S. mansoni in a college setting warrants mass drug administration with praziquantel. This population of young adults is &amp;lsquo;in school&amp;rsquo; and is both approachable and worthy of inclusion in national schistosomiasis control and elimination programs.TropicalMed, Vol. 3, Pages 100: Young Adults in Endemic Areas: An Untreated Group in Need of School-Based Preventive Chemotherapy for Schistosomiasis Control and Elimination

Parasitologic surveys of young adults in college and university settings are not commonly done, even in areas known to be endemic for schistosomiasis and soil-transmitted helminths. We have done a survey of 291 students and staff at the Kisumu National Polytechnic in Kisumu, Kenya, using the stool microscopy Kato-Katz (KK) method and the urine point-of-care circulating cathodic antigen (POC-CCA) test. Based on three stools/two KK slides each, in the 208 participants for whom three consecutive stools were obtained, Schistosoma mansoni prevalence was 17.8%. When all 291 individuals were analyzed based on the first stool, as done by the national neglected tropical disease (NTD) program, and one urine POC-CCA assay (n = 276), the prevalence was 13.7% by KK and 23.2% by POC-CCA. Based on three stools, 2.5% of 208 participants had heavy S. mansoni infections (&amp;ge;400 eggs/gram feces), with heavy S. mansoni infections making up 13.5% of the S. mansoni cases. The prevalence of the soil-transmitted helminths (STH: Ascaris lumbricoides, Trichuris trichiura and hookworm) by three stools was 1.4%, 3.1%, and 4.1%, respectively, and by the first stool was 1.4%, 2.4% and 1.4%, respectively. This prevalence and intensity of infection with S. mansoni in a college setting warrants mass drug administration with praziquantel. This population of young adults is &amp;lsquo;in school&amp;rsquo; and is both approachable and worthy of inclusion in national schistosomiasis control and elimination programs.

]]>Young Adults in Endemic Areas: An Untreated Group in Need of School-Based Preventive Chemotherapy for Schistosomiasis Control and Elimination Korir Riner Kavere Omondi Landry Kittur Ndombi Ondigo Secor Karanja Colleydoi: 10.3390/tropicalmed3030100Tropical Medicine and Infectious Disease2018-09-05Tropical Medicine and Infectious Disease2018-09-0533Article10010.3390/tropicalmed3030100http://www.mdpi.com/2414-6366/3/3/100TropicalMed, Vol. 3, Pages 99: Melioidosis in the Philippineshttp://www.mdpi.com/2414-6366/3/3/99
The first documented case of melioidosis in the Philippines occurred in 1948. Since then, there have been sporadic reports in the literature about travelers diagnosed with melioidosis after returning from the Philippines. Indigenous cases, however, have been documented rarely, and under-reporting is highly likely. This review collated all Philippine cases of melioidosis published internationally and locally, as well as unpublished case series and reports from different tertiary hospitals in the Philippines. In total, 25 papers and 41 cases were identified. Among these, 23 were indigenous cases (of which 20 have not been previously reported in the literature). The most common co-morbidity present was diabetes mellitus, and the most common presentations were pulmonary and soft tissue infections. Most of the cases received ceftazidime during the intensive phase, while trimethoprim-sulfamethoxazole was given during the eradication phase. The known mortality rate was 14.6%, while 4.9% of all cases were reported to have had recurrence. The true burden of melioidosis in the country is not well defined. A lack of awareness among clinicians, a dearth of adequate laboratories, and the absence of a surveillance system for the disease are major challenges in determining the magnitude of the problem.TropicalMed, Vol. 3, Pages 99: Melioidosis in the Philippines

The first documented case of melioidosis in the Philippines occurred in 1948. Since then, there have been sporadic reports in the literature about travelers diagnosed with melioidosis after returning from the Philippines. Indigenous cases, however, have been documented rarely, and under-reporting is highly likely. This review collated all Philippine cases of melioidosis published internationally and locally, as well as unpublished case series and reports from different tertiary hospitals in the Philippines. In total, 25 papers and 41 cases were identified. Among these, 23 were indigenous cases (of which 20 have not been previously reported in the literature). The most common co-morbidity present was diabetes mellitus, and the most common presentations were pulmonary and soft tissue infections. Most of the cases received ceftazidime during the intensive phase, while trimethoprim-sulfamethoxazole was given during the eradication phase. The known mortality rate was 14.6%, while 4.9% of all cases were reported to have had recurrence. The true burden of melioidosis in the country is not well defined. A lack of awareness among clinicians, a dearth of adequate laboratories, and the absence of a surveillance system for the disease are major challenges in determining the magnitude of the problem.

]]>Melioidosis in the PhilippinesPeter Franz M. San MartinJoseph C. ChuaRalph Louie P. BautistaJennifer M. NailesMario M. PanaliganDavid A. B. Dancedoi: 10.3390/tropicalmed3030099Tropical Medicine and Infectious Disease2018-09-05Tropical Medicine and Infectious Disease2018-09-0533Article9910.3390/tropicalmed3030099http://www.mdpi.com/2414-6366/3/3/99TropicalMed, Vol. 3, Pages 98: Control Strategies for Scabieshttp://www.mdpi.com/2414-6366/3/3/98
Scabies is a neglected tropical disease of the skin, causing severe itching and stigmatizing skin lesions. Further, scabies leads to impetigo, severe bacterial infections, and post-infectious complications. Around 200 million people are affected, particularly among disadvantaged populations living in crowded conditions in tropical areas. After almost 50 years, research into scabies control has shown great promise, particularly in highly-endemic island settings, but these findings have not been widely adopted. Newer approaches, utilizing ivermectin-based mass drug administration, appear feasible and highly effective. Inclusion of scabies in the WHO portfolio of neglected tropical diseases in 2017 may facilitate renewed opportunities and momentum toward global control. However, further operational research is needed to develop evidence-based strategies for control in a range of settings, and monitor their impact. Several enabling factors are required for successful implementation, including availability of affordable drug supply. Integration with existing health programs may provide a cost-effective approach to control.TropicalMed, Vol. 3, Pages 98: Control Strategies for Scabies

Scabies is a neglected tropical disease of the skin, causing severe itching and stigmatizing skin lesions. Further, scabies leads to impetigo, severe bacterial infections, and post-infectious complications. Around 200 million people are affected, particularly among disadvantaged populations living in crowded conditions in tropical areas. After almost 50 years, research into scabies control has shown great promise, particularly in highly-endemic island settings, but these findings have not been widely adopted. Newer approaches, utilizing ivermectin-based mass drug administration, appear feasible and highly effective. Inclusion of scabies in the WHO portfolio of neglected tropical diseases in 2017 may facilitate renewed opportunities and momentum toward global control. However, further operational research is needed to develop evidence-based strategies for control in a range of settings, and monitor their impact. Several enabling factors are required for successful implementation, including availability of affordable drug supply. Integration with existing health programs may provide a cost-effective approach to control.

]]>Control Strategies for ScabiesDaniel EngelmanAndrew C. Steerdoi: 10.3390/tropicalmed3030098Tropical Medicine and Infectious Disease2018-09-05Tropical Medicine and Infectious Disease2018-09-0533Review9810.3390/tropicalmed3030098http://www.mdpi.com/2414-6366/3/3/98TropicalMed, Vol. 3, Pages 97: Mycetoma: The Spectrum of Clinical Presentationhttp://www.mdpi.com/2414-6366/3/3/97
Mycetoma is a chronic infection, newly designated by the World Health Organization (WHO) as a neglected tropical disease, which is endemic in tropical and subtropical regions. It follows implantation of infectious organisms, either fungi (eumycetomas) or filamentous bacteria (actinomycetomas) into subcutaneous tissue, from where infection spreads to involve skin, bone and subcutaneous sites, leading to both health related and socioeconomic problems. In common with other NTDs, mycetoma is most often seen in rural areas amongst the poorest of people who have less access to health care. The organisms form small microcolonies that are discharged onto the skin surface via sinus tracts, or that can burrow into other adjacent tissues including bone. This paper describes the clinical features of mycetoma, as early recognition is a key to early diagnosis and the institution of appropriate treatment including surgery. Because these lesions are mostly painless and the majority of infected individuals present late and with advanced disease, simplifying early recognition is an important public health goal.TropicalMed, Vol. 3, Pages 97: Mycetoma: The Spectrum of Clinical Presentation

Mycetoma is a chronic infection, newly designated by the World Health Organization (WHO) as a neglected tropical disease, which is endemic in tropical and subtropical regions. It follows implantation of infectious organisms, either fungi (eumycetomas) or filamentous bacteria (actinomycetomas) into subcutaneous tissue, from where infection spreads to involve skin, bone and subcutaneous sites, leading to both health related and socioeconomic problems. In common with other NTDs, mycetoma is most often seen in rural areas amongst the poorest of people who have less access to health care. The organisms form small microcolonies that are discharged onto the skin surface via sinus tracts, or that can burrow into other adjacent tissues including bone. This paper describes the clinical features of mycetoma, as early recognition is a key to early diagnosis and the institution of appropriate treatment including surgery. Because these lesions are mostly painless and the majority of infected individuals present late and with advanced disease, simplifying early recognition is an important public health goal.

]]>Mycetoma: The Spectrum of Clinical PresentationAhmed Hassan FahalSuliman Hussein SulimanRoderick Haydoi: 10.3390/tropicalmed3030097Tropical Medicine and Infectious Disease2018-09-04Tropical Medicine and Infectious Disease2018-09-0433Review9710.3390/tropicalmed3030097http://www.mdpi.com/2414-6366/3/3/97TropicalMed, Vol. 3, Pages 96: Acute Poisonings at a Regional Referral Hospital in Western Kenyahttp://www.mdpi.com/2414-6366/3/3/96
The emergency department (ED) of the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) handles many cases of poisoning. However, there is scant information on the factors, agents, and outcomes of poisoning at the hospital. The aim of this work was to determine the factors, agents, and outcomes of poisoning at JOOTRH. Records of patients who presented to JOOTRH with symptoms of poisoning between January 2011 and December 2016 were retrieved. Data on age, gender, offending agents, time, and season of exposure were collected. Information on the route of exposure, motive, and clinical symptoms of poisoning was also included. Other information included the laboratory evaluation, first aid measures, period of hospitalization, and outcome of poisoning. Mean, standard deviation, frequencies and bar graphs were used to describe the demographic factors of the study population. Multivariate logistic regression was used to determine the strength of association between risk factors and outcome of poisoning among patients. The level of significance for inferential analysis was set at 5%. There were 385 cases of poisoning: 57.9% (223/385) were male, 31.9% (123/385) were 13&amp;ndash;24 years of age, and 83.9% (323/385) of exposures were in Kisumu County. The peak time of exposure was 6:00&amp;ndash;00:00, and 23.6% (91/385) presented 1&amp;ndash;4 h after exposure. About 62.9% (242/385) of the cases were due to accidental poisoning. Snakebites and organophosphates (OPPs) contributed to 33.0% (127/385) and 22.1% (85/385) of all cases, respectively. About 62.1% (239/385) of exposures were oral, and 63.9% (246/385) of all cases occurred in the rainy season. Additionally, 49.2% (60/122) of intentional poisoning was due to family disputes, and 16.1% (10/62) of pre-hospital first aid involved the use of tourniquets and herbal medicine. About 28.6% (110/385) of the victims were subjected to laboratory evaluation and 83.9% (323/385) were hospitalized for between 1&amp;ndash;5 days. Other results indicated that 80.0% (308/385) responded well to therapy, while 7.3% (28/385) died, 68% (19/28) of whom were male. Furthermore, 39.3% (11/28) of the deaths were related to OPPs. Our findings suggest that the earlier the victims of poisoning get to the hospital, the more likely they are to survive after treatment is initiated. Similarly, victims of poisoning due to parental negligence are more likely to survive after treatment compared to other causes of poisoning, including family disputes, love affairs, snakebites, and psychiatric disorders. The management of JOOTRH should consider allocating resources to support the development of poison management and control.TropicalMed, Vol. 3, Pages 96: Acute Poisonings at a Regional Referral Hospital in Western Kenya

The emergency department (ED) of the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) handles many cases of poisoning. However, there is scant information on the factors, agents, and outcomes of poisoning at the hospital. The aim of this work was to determine the factors, agents, and outcomes of poisoning at JOOTRH. Records of patients who presented to JOOTRH with symptoms of poisoning between January 2011 and December 2016 were retrieved. Data on age, gender, offending agents, time, and season of exposure were collected. Information on the route of exposure, motive, and clinical symptoms of poisoning was also included. Other information included the laboratory evaluation, first aid measures, period of hospitalization, and outcome of poisoning. Mean, standard deviation, frequencies and bar graphs were used to describe the demographic factors of the study population. Multivariate logistic regression was used to determine the strength of association between risk factors and outcome of poisoning among patients. The level of significance for inferential analysis was set at 5%. There were 385 cases of poisoning: 57.9% (223/385) were male, 31.9% (123/385) were 13&amp;ndash;24 years of age, and 83.9% (323/385) of exposures were in Kisumu County. The peak time of exposure was 6:00&amp;ndash;00:00, and 23.6% (91/385) presented 1&amp;ndash;4 h after exposure. About 62.9% (242/385) of the cases were due to accidental poisoning. Snakebites and organophosphates (OPPs) contributed to 33.0% (127/385) and 22.1% (85/385) of all cases, respectively. About 62.1% (239/385) of exposures were oral, and 63.9% (246/385) of all cases occurred in the rainy season. Additionally, 49.2% (60/122) of intentional poisoning was due to family disputes, and 16.1% (10/62) of pre-hospital first aid involved the use of tourniquets and herbal medicine. About 28.6% (110/385) of the victims were subjected to laboratory evaluation and 83.9% (323/385) were hospitalized for between 1&amp;ndash;5 days. Other results indicated that 80.0% (308/385) responded well to therapy, while 7.3% (28/385) died, 68% (19/28) of whom were male. Furthermore, 39.3% (11/28) of the deaths were related to OPPs. Our findings suggest that the earlier the victims of poisoning get to the hospital, the more likely they are to survive after treatment is initiated. Similarly, victims of poisoning due to parental negligence are more likely to survive after treatment compared to other causes of poisoning, including family disputes, love affairs, snakebites, and psychiatric disorders. The management of JOOTRH should consider allocating resources to support the development of poison management and control.

]]>Acute Poisonings at a Regional Referral Hospital in Western KenyaMitchel Otieno OkumuMinal Naran PatelForam Rajnkant BhogayataIrene Awuor OlwenyFrancis Okumu OcholaJoshua Orungo Ononodoi: 10.3390/tropicalmed3030096Tropical Medicine and Infectious Disease2018-09-03Tropical Medicine and Infectious Disease2018-09-0333Article9610.3390/tropicalmed3030096http://www.mdpi.com/2414-6366/3/3/96TropicalMed, Vol. 3, Pages 95: Diagnostic Accuracy of the InBios Scrub Typhus Detect™ ELISA for the Detection of IgM Antibodies in Chittagong, Bangladeshhttp://www.mdpi.com/2414-6366/3/3/95
Here we estimated the accuracy of the InBios Scrub Typhus Detect&amp;trade; immunoglobulin M (IgM) ELISA to determine the optimal optical density (OD) cut-off values for the diagnosis of scrub typhus. Patients with undifferentiated febrile illness from Chittagong, Bangladesh, provided samples for reference testing using (i) qPCR using the Orientia spp. 47-kDa htra gene, (ii) IFA &amp;ge;1:3200 on admission, (iii) immunofluorescence assay (IFA) &amp;ge;1:3200 on admission or 4-fold rise to &amp;ge;3200, and (iv) combination of PCR and IFA positivity. For sero-epidemiological purposes (ELISA vs. IFA &amp;ge;1:3200 on admission or 4-fold rise to &amp;ge;3200), the OD cut-off for admission samples was &amp;ge;1.25, resulting in a sensitivity (Sn) of 91.5 (95% confidence interval (95% CI: 96.8&amp;ndash;82.5) and a specificity (Sp) of 92.4 (95% CI: 95.0&amp;ndash;89.0), while for convalescent samples the OD cut-off was &amp;ge;1.50 with Sn of 66.0 (95% CI: 78.5&amp;ndash;51.7) and Sp of 96.0 (95% CI: 98.3&amp;ndash;92.3). Comparisons against comparator reference tests (ELISA vs. all tests including PCR) indicated the most appropriate cut-off OD to be within the range of 0.75&amp;ndash;1.25. For admission samples, the best Sn/Sp compromise was at 1.25 OD (Sn 91.5%, Sp 92.4%) and for convalescent samples at 0.75 OD (Sn 69.8%, Sp 89.5%). A relatively high (stringent) diagnostic cut-off value provides increased diagnostic accuracy with high sensitivity and specificity in the majority of cases, while lowering the cut-off runs the risk of false positivity. This study underlines the need for regional assessment of new diagnostic tests according to the level of endemicity of the disease given the high levels of residual or cross-reacting antibodies in the general population.TropicalMed, Vol. 3, Pages 95: Diagnostic Accuracy of the InBios Scrub Typhus Detect™ ELISA for the Detection of IgM Antibodies in Chittagong, Bangladesh

Here we estimated the accuracy of the InBios Scrub Typhus Detect&amp;trade; immunoglobulin M (IgM) ELISA to determine the optimal optical density (OD) cut-off values for the diagnosis of scrub typhus. Patients with undifferentiated febrile illness from Chittagong, Bangladesh, provided samples for reference testing using (i) qPCR using the Orientia spp. 47-kDa htra gene, (ii) IFA &amp;ge;1:3200 on admission, (iii) immunofluorescence assay (IFA) &amp;ge;1:3200 on admission or 4-fold rise to &amp;ge;3200, and (iv) combination of PCR and IFA positivity. For sero-epidemiological purposes (ELISA vs. IFA &amp;ge;1:3200 on admission or 4-fold rise to &amp;ge;3200), the OD cut-off for admission samples was &amp;ge;1.25, resulting in a sensitivity (Sn) of 91.5 (95% confidence interval (95% CI: 96.8&amp;ndash;82.5) and a specificity (Sp) of 92.4 (95% CI: 95.0&amp;ndash;89.0), while for convalescent samples the OD cut-off was &amp;ge;1.50 with Sn of 66.0 (95% CI: 78.5&amp;ndash;51.7) and Sp of 96.0 (95% CI: 98.3&amp;ndash;92.3). Comparisons against comparator reference tests (ELISA vs. all tests including PCR) indicated the most appropriate cut-off OD to be within the range of 0.75&amp;ndash;1.25. For admission samples, the best Sn/Sp compromise was at 1.25 OD (Sn 91.5%, Sp 92.4%) and for convalescent samples at 0.75 OD (Sn 69.8%, Sp 89.5%). A relatively high (stringent) diagnostic cut-off value provides increased diagnostic accuracy with high sensitivity and specificity in the majority of cases, while lowering the cut-off runs the risk of false positivity. This study underlines the need for regional assessment of new diagnostic tests according to the level of endemicity of the disease given the high levels of residual or cross-reacting antibodies in the general population.

]]>Diagnostic Accuracy of the InBios Scrub Typhus Detect™ ELISA for the Detection of IgM Antibodies in Chittagong, BangladeshStuart D. BlacksellHugh W. F. KingstonAmpai TanganuchitcharnchaiMeghna PhanichkrivalkosilMosharraf HossainAmir HossainAniruddha GhoseStije J. LeopoldArjen M. DondorpNicholas P. J. DayDaniel H. Parisdoi: 10.3390/tropicalmed3030095Tropical Medicine and Infectious Disease2018-09-01Tropical Medicine and Infectious Disease2018-09-0133Article9510.3390/tropicalmed3030095http://www.mdpi.com/2414-6366/3/3/95TropicalMed, Vol. 3, Pages 94: Onchodermatitis: Where Are We Now?http://www.mdpi.com/2414-6366/3/3/94
Onchocerciasis causes debilitating pruritus and rashes as well as visual impairment and blindness. Prior to control measures, eye disease was particularly prominent in savanna areas of sub-Saharan Africa whilst skin disease was more common across rainforest regions of tropical Africa. Mass drug distribution with ivermectin is changing the global scene of onchocerciasis. There has been successful progressive elimination in Central and Southern American countries and the World Health Organization has set a target for elimination in Africa of 2025. This literature review was conducted to examine progress regarding onchocercal skin disease. PubMed searches were performed using keywords &amp;lsquo;onchocerciasis&amp;rsquo;, &amp;lsquo;onchodermatitis&amp;rsquo; and &amp;lsquo;onchocercal skin disease&amp;rsquo; over the past eight years. Articles in English, or with an English abstract, were assessed for relevance, including any pertinent references within the articles. Recent progress in awareness of, understanding and treatment of onchocercal skin disease is reviewed with particular emphasis on publications within the past five years. The global burden of onchodermatitis is progressively reducing and is no longer seen in children in many formerly endemic foci.TropicalMed, Vol. 3, Pages 94: Onchodermatitis: Where Are We Now?

Onchocerciasis causes debilitating pruritus and rashes as well as visual impairment and blindness. Prior to control measures, eye disease was particularly prominent in savanna areas of sub-Saharan Africa whilst skin disease was more common across rainforest regions of tropical Africa. Mass drug distribution with ivermectin is changing the global scene of onchocerciasis. There has been successful progressive elimination in Central and Southern American countries and the World Health Organization has set a target for elimination in Africa of 2025. This literature review was conducted to examine progress regarding onchocercal skin disease. PubMed searches were performed using keywords &amp;lsquo;onchocerciasis&amp;rsquo;, &amp;lsquo;onchodermatitis&amp;rsquo; and &amp;lsquo;onchocercal skin disease&amp;rsquo; over the past eight years. Articles in English, or with an English abstract, were assessed for relevance, including any pertinent references within the articles. Recent progress in awareness of, understanding and treatment of onchocercal skin disease is reviewed with particular emphasis on publications within the past five years. The global burden of onchodermatitis is progressively reducing and is no longer seen in children in many formerly endemic foci.

]]>Onchodermatitis: Where Are We Now?Michele E. Murdochdoi: 10.3390/tropicalmed3030094Tropical Medicine and Infectious Disease2018-09-01Tropical Medicine and Infectious Disease2018-09-0133Review9410.3390/tropicalmed3030094http://www.mdpi.com/2414-6366/3/3/94TropicalMed, Vol. 3, Pages 93: ‘Know Your Epidemic’: Are Prisons a Potential Barrier to TB Elimination in an Australian Context?http://www.mdpi.com/2414-6366/3/3/93
Globally, rates of tuberculosis (TB) cases in prisons are substantially higher than in the general population. The goal of this study was to review TB notifications in Victorian correctional facilities, and consider whether additional interventions towards TB elimination may be useful in this setting. All patients who were notified with or treated for TB in the Australian state of Victoria from 1 January 2003 to 1 December 2017 were included in this study. Descriptive analysis was performed. Demographic and treatment outcome data for individuals with and without a history of incarceration were reviewed and compared. Of the 5645 TB cases notified during the study period, 26 (0.5%) had a history of being incarcerated in correctional facilities while receiving treatment for TB. There were 73,238 inmates in Victorian correctional facilities over the same study period, meaning that approximately 0.04% of inmates were diagnosed or treated with TB disease in correctional facilities. Incarcerated individuals were more likely to have positive sputum smears and cavitation compared with nonincarcerated people with TB. There was no significant difference in treatment outcomes between the general TB population and those who had a history of incarceration during their treatment. There is a low apparent rate of TB in Victorian prisoners, and prisons do not contribute significantly to TB incidence in Victoria. Overall, TB outcomes do not differ between prisoners and nonprisoners. Ongoing efforts to sustain these lower rates and comparable outcomes in this vulnerable cohort are important for continued progress towards TB elimination.TropicalMed, Vol. 3, Pages 93: ‘Know Your Epidemic’: Are Prisons a Potential Barrier to TB Elimination in an Australian Context?

Globally, rates of tuberculosis (TB) cases in prisons are substantially higher than in the general population. The goal of this study was to review TB notifications in Victorian correctional facilities, and consider whether additional interventions towards TB elimination may be useful in this setting. All patients who were notified with or treated for TB in the Australian state of Victoria from 1 January 2003 to 1 December 2017 were included in this study. Descriptive analysis was performed. Demographic and treatment outcome data for individuals with and without a history of incarceration were reviewed and compared. Of the 5645 TB cases notified during the study period, 26 (0.5%) had a history of being incarcerated in correctional facilities while receiving treatment for TB. There were 73,238 inmates in Victorian correctional facilities over the same study period, meaning that approximately 0.04% of inmates were diagnosed or treated with TB disease in correctional facilities. Incarcerated individuals were more likely to have positive sputum smears and cavitation compared with nonincarcerated people with TB. There was no significant difference in treatment outcomes between the general TB population and those who had a history of incarceration during their treatment. There is a low apparent rate of TB in Victorian prisoners, and prisons do not contribute significantly to TB incidence in Victoria. Overall, TB outcomes do not differ between prisoners and nonprisoners. Ongoing efforts to sustain these lower rates and comparable outcomes in this vulnerable cohort are important for continued progress towards TB elimination.

]]>‘Know Your Epidemic’: Are Prisons a Potential Barrier to TB Elimination in an Australian Context?Nompilo MoyoEe Laine TayJustin Denholmdoi: 10.3390/tropicalmed3030093Tropical Medicine and Infectious Disease2018-08-31Tropical Medicine and Infectious Disease2018-08-3133Article9310.3390/tropicalmed3030093http://www.mdpi.com/2414-6366/3/3/93TropicalMed, Vol. 3, Pages 92: Advances in the Treatment of Yawshttp://www.mdpi.com/2414-6366/3/3/92
Yaws is one of the three endemic treponematoses and is recognised by the World Health Organization as a neglected tropical disease. Yaws is currently reported in 15 countries in the Pacific, South-East Asia, West and Central Africa, predominantly affects children, and results in destructive lesions of the skin and soft tissues. For most of the twentieth century penicillin-based treatment was the standard of care and resistance to penicillin has still not been described. Recently, oral azithromycin has been shown to be an effective treatment for yaws, facilitating renewed yaws eradication efforts. Resistance to azithromycin is an emerging threat and close surveillance will be required as yaws eradication efforts are scaled up globally.TropicalMed, Vol. 3, Pages 92: Advances in the Treatment of Yaws

Yaws is one of the three endemic treponematoses and is recognised by the World Health Organization as a neglected tropical disease. Yaws is currently reported in 15 countries in the Pacific, South-East Asia, West and Central Africa, predominantly affects children, and results in destructive lesions of the skin and soft tissues. For most of the twentieth century penicillin-based treatment was the standard of care and resistance to penicillin has still not been described. Recently, oral azithromycin has been shown to be an effective treatment for yaws, facilitating renewed yaws eradication efforts. Resistance to azithromycin is an emerging threat and close surveillance will be required as yaws eradication efforts are scaled up globally.

]]>Advances in the Treatment of YawsMichael Marksdoi: 10.3390/tropicalmed3030092Tropical Medicine and Infectious Disease2018-08-29Tropical Medicine and Infectious Disease2018-08-2933Review9210.3390/tropicalmed3030092http://www.mdpi.com/2414-6366/3/3/92TropicalMed, Vol. 3, Pages 91: Melioidosis in Hong Konghttp://www.mdpi.com/2414-6366/3/3/91
Melioidosis, although endemic in many parts of Southeast Asia, has not been systematically studied in Hong Kong, which is a predominantly urban area located in the subtropics. This review describes the early outbreaks of melioidosis in captive animals in Hong Kong in the 1970s, as well as the early reports of human clinical cases in the 1980s. A review of all hospitalized human cases of culture-confirmed melioidosis in the last twenty years showed an increasing trend in the incidence of the disease, with significant mortality observed. The lack of awareness of this disease among local physicians, the delay in laboratory diagnosis and the lack of epidemiological surveillance are among the greatest challenges of managing melioidosis in the territory.TropicalMed, Vol. 3, Pages 91: Melioidosis in Hong Kong

Melioidosis, although endemic in many parts of Southeast Asia, has not been systematically studied in Hong Kong, which is a predominantly urban area located in the subtropics. This review describes the early outbreaks of melioidosis in captive animals in Hong Kong in the 1970s, as well as the early reports of human clinical cases in the 1980s. A review of all hospitalized human cases of culture-confirmed melioidosis in the last twenty years showed an increasing trend in the incidence of the disease, with significant mortality observed. The lack of awareness of this disease among local physicians, the delay in laboratory diagnosis and the lack of epidemiological surveillance are among the greatest challenges of managing melioidosis in the territory.

]]>Melioidosis in Hong KongGrace LuiAnthony TamEugene TsoAlan WuJonpaul ZeeKin ChoiWilson LamMan ChanWan TingIvan Hungdoi: 10.3390/tropicalmed3030091Tropical Medicine and Infectious Disease2018-08-25Tropical Medicine and Infectious Disease2018-08-2533Review9110.3390/tropicalmed3030091http://www.mdpi.com/2414-6366/3/3/91TropicalMed, Vol. 3, Pages 90: First Case Report of a Near Lethal Envenomation by a Salomonelaps par (Solomons Coral Snake) in the Solomon Islandshttp://www.mdpi.com/2414-6366/3/3/90
Venomous snake bites in the Solomon Islands can be very dangerous due to lack of access to health care. There are no documented case reports of envenomation by snake bites in the Solomon Islands. This case report highlights the management of a patient with potentially lethal neurotoxicity secondary to a Solomonelaps par (Solomons coral snake) in a low resource setting. This case identifies the potential benefit of further research to determine the incidence of lethal envenomation as well as analysing the venom to determine if any commercially available antivenom would be useful in the treatment of envenomation by Salomonelaps par and other venomous snakes. There should be consideration given to providing education on first aid for people living in remote areas as well as education for health workers.TropicalMed, Vol. 3, Pages 90: First Case Report of a Near Lethal Envenomation by a Salomonelaps par (Solomons Coral Snake) in the Solomon Islands

Venomous snake bites in the Solomon Islands can be very dangerous due to lack of access to health care. There are no documented case reports of envenomation by snake bites in the Solomon Islands. This case report highlights the management of a patient with potentially lethal neurotoxicity secondary to a Solomonelaps par (Solomons coral snake) in a low resource setting. This case identifies the potential benefit of further research to determine the incidence of lethal envenomation as well as analysing the venom to determine if any commercially available antivenom would be useful in the treatment of envenomation by Salomonelaps par and other venomous snakes. There should be consideration given to providing education on first aid for people living in remote areas as well as education for health workers.

]]>First Case Report of a Near Lethal Envenomation by a Salomonelaps par (Solomons Coral Snake) in the Solomon IslandsSarah LuthyDamian RakeTanya BuchananChristine Schultzedoi: 10.3390/tropicalmed3030090Tropical Medicine and Infectious Disease2018-08-21Tropical Medicine and Infectious Disease2018-08-2133Case Report9010.3390/tropicalmed3030090http://www.mdpi.com/2414-6366/3/3/90TropicalMed, Vol. 3, Pages 89: Rabies in the Caribbean: A Situational Analysis and Historic Reviewhttp://www.mdpi.com/2414-6366/3/3/89
Rabies virus is the only Lyssavirus species found in the Americas. In discussions about rabies, Latin America and the Caribbean are often grouped together. Our study aimed to independently analyse the rabies situation in the Caribbean and examine changes in rabies spatiotemporal epidemiology. A questionnaire was administered to the 33 member countries and territories of the Caribbean Animal Health Network (CaribVET) to collect current data, which was collated with a literature review. Rabies was endemic in ten Caribbean localities, with the dog, mongoose, and vampire bat identified as enzootic reservoirs. The majority of animal cases occurred in Puerto Rico, the Dominican Republic, and Haiti, while human cases only consistently occurred in the latter two areas. Rabies vaccination was conducted for high-risk animal populations with variable coverage, and rabies diagnostic capacities varied widely throughout the region. Illegal importation and natural migration of animals may facilitate the introduction of rabies virus variants into virus-na&amp;iuml;ve areas. Passive surveillance, together with enhanced methods and serological screening techniques, can therefore be of value. The insularity of the Caribbean makes it ideal for conducting pilot studies on reservoir host population management. Best practice guidelines developed for these reservoir hosts can be individually modified to the epidemiological status and available resources within each locality.TropicalMed, Vol. 3, Pages 89: Rabies in the Caribbean: A Situational Analysis and Historic Review

Rabies virus is the only Lyssavirus species found in the Americas. In discussions about rabies, Latin America and the Caribbean are often grouped together. Our study aimed to independently analyse the rabies situation in the Caribbean and examine changes in rabies spatiotemporal epidemiology. A questionnaire was administered to the 33 member countries and territories of the Caribbean Animal Health Network (CaribVET) to collect current data, which was collated with a literature review. Rabies was endemic in ten Caribbean localities, with the dog, mongoose, and vampire bat identified as enzootic reservoirs. The majority of animal cases occurred in Puerto Rico, the Dominican Republic, and Haiti, while human cases only consistently occurred in the latter two areas. Rabies vaccination was conducted for high-risk animal populations with variable coverage, and rabies diagnostic capacities varied widely throughout the region. Illegal importation and natural migration of animals may facilitate the introduction of rabies virus variants into virus-na&amp;iuml;ve areas. Passive surveillance, together with enhanced methods and serological screening techniques, can therefore be of value. The insularity of the Caribbean makes it ideal for conducting pilot studies on reservoir host population management. Best practice guidelines developed for these reservoir hosts can be individually modified to the epidemiological status and available resources within each locality.

]]>Rabies in the Caribbean: A Situational Analysis and Historic ReviewJanine F. R. SeetahalAlexandra VokatyMarco A. N. VigilatoChristine V. F. CarringtonJennifer PradelBowen LouisonAstrid Van SauersRohini RoopnarineJusayma C. González ArrebatoMax F. MillienColin JamesCharles E. Rupprechtdoi: 10.3390/tropicalmed3030089Tropical Medicine and Infectious Disease2018-08-20Tropical Medicine and Infectious Disease2018-08-2033Article8910.3390/tropicalmed3030089http://www.mdpi.com/2414-6366/3/3/89TropicalMed, Vol. 3, Pages 88: A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa)http://www.mdpi.com/2414-6366/3/3/88
In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert’s response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.TropicalMed, Vol. 3, Pages 88: A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa)

In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert’s response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.

]]>A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa)Ousmane FayeCheick BagayokoAdama DickoLamissa CisséSiritio BerthéBekaye TraoréYoussouf FofanaMahamoudan NiangSeydou TraoréYamoussa KarabintaMamadou GassamaBinta GuindoAlimata KeitaKoreissi TallSomita KeitaAntoine GeissbuhlerAntoine Mahé Teledermali Teamdoi: 10.3390/tropicalmed3030088Tropical Medicine and Infectious Disease2018-08-17Tropical Medicine and Infectious Disease2018-08-1733Article8810.3390/tropicalmed3030088http://www.mdpi.com/2414-6366/3/3/88TropicalMed, Vol. 3, Pages 87: Community Involvement in the Care of Persons Affected by Podoconiosis—A Lesson for Other Skin NTDshttp://www.mdpi.com/2414-6366/3/3/87
Podoconiosis is a neglected tropical disease (NTD) characterized by lower-leg swelling (lymphedema), which is caused by long-term exposure to irritant red-clay soils found within tropical volcanic high-altitude environments with heavy rainfall. The condition places a substantial burden on affected people, their families and communities, including disability, economic consequences, social exclusion, and stigma; mental disorders and distress are also common. This paper focuses on community-based care of podoconiosis, and, in particular, the role that community involvement can have in the reduction of stigma against people affected by podoconiosis. We first draw on research conducted in Ethiopia for this, which has included community-based provision of care and treatment, education, and awareness-raising, and socioeconomic rehabilitation to reduce stigma. Since people affected by podoconiosis and other skin NTDs often suffer the double burden of mental-health illness, which is similarly stigmatized, we then point to examples from the mental-health field in low-resource community settings to suggest avenues for stigma reduction and increased patient engagement that may be relevant across a range of skin NTDs, though further research is needed on this.TropicalMed, Vol. 3, Pages 87: Community Involvement in the Care of Persons Affected by Podoconiosis—A Lesson for Other Skin NTDs

Podoconiosis is a neglected tropical disease (NTD) characterized by lower-leg swelling (lymphedema), which is caused by long-term exposure to irritant red-clay soils found within tropical volcanic high-altitude environments with heavy rainfall. The condition places a substantial burden on affected people, their families and communities, including disability, economic consequences, social exclusion, and stigma; mental disorders and distress are also common. This paper focuses on community-based care of podoconiosis, and, in particular, the role that community involvement can have in the reduction of stigma against people affected by podoconiosis. We first draw on research conducted in Ethiopia for this, which has included community-based provision of care and treatment, education, and awareness-raising, and socioeconomic rehabilitation to reduce stigma. Since people affected by podoconiosis and other skin NTDs often suffer the double burden of mental-health illness, which is similarly stigmatized, we then point to examples from the mental-health field in low-resource community settings to suggest avenues for stigma reduction and increased patient engagement that may be relevant across a range of skin NTDs, though further research is needed on this.

]]>Community Involvement in the Care of Persons Affected by Podoconiosis—A Lesson for Other Skin NTDsAbebayehu ToraAsrat MengisteGail DaveyMaya Semraudoi: 10.3390/tropicalmed3030087Tropical Medicine and Infectious Disease2018-08-16Tropical Medicine and Infectious Disease2018-08-1633Review8710.3390/tropicalmed3030087http://www.mdpi.com/2414-6366/3/3/87TropicalMed, Vol. 3, Pages 86: Treading the Path towards Genetic Control of Snail Resistance to Schistosome Infectionhttp://www.mdpi.com/2414-6366/3/3/86
Schistosomiasis remains the most important tropical snail-borne trematodiasis that threatens many millions of human lives. In achieving schistosomiasis elimination targets, sustainable control of the snail vectors represents a logical approach. Nonetheless, the ineffectiveness of the present snail control interventions emphasizes the need to develop new complementary strategies to ensure more effective control outcomes. Accordingly, the use of genetic techniques aimed at driving resistance traits into natural vector populations has been put forward as a promising tool for integrated snail control. Leveraging the Biomphalaria-Schistosoma model system, studies unraveling the complexities of the vector biology and those exploring the molecular basis of snail resistance to schistosome infection have been expanding in various breadths, generating many significant discoveries, and raising the hope for future breakthroughs. This review provides a compendium of relevant findings, and without neglecting the current existing gaps and potential future challenges, discusses how a transgenic snail approach may be adapted and harnessed to control human schistosomiasis.TropicalMed, Vol. 3, Pages 86: Treading the Path towards Genetic Control of Snail Resistance to Schistosome Infection

Schistosomiasis remains the most important tropical snail-borne trematodiasis that threatens many millions of human lives. In achieving schistosomiasis elimination targets, sustainable control of the snail vectors represents a logical approach. Nonetheless, the ineffectiveness of the present snail control interventions emphasizes the need to develop new complementary strategies to ensure more effective control outcomes. Accordingly, the use of genetic techniques aimed at driving resistance traits into natural vector populations has been put forward as a promising tool for integrated snail control. Leveraging the Biomphalaria-Schistosoma model system, studies unraveling the complexities of the vector biology and those exploring the molecular basis of snail resistance to schistosome infection have been expanding in various breadths, generating many significant discoveries, and raising the hope for future breakthroughs. This review provides a compendium of relevant findings, and without neglecting the current existing gaps and potential future challenges, discusses how a transgenic snail approach may be adapted and harnessed to control human schistosomiasis.

]]>Treading the Path towards Genetic Control of Snail Resistance to Schistosome InfectionDamilare O. Famakindedoi: 10.3390/tropicalmed3030086Tropical Medicine and Infectious Disease2018-08-15Tropical Medicine and Infectious Disease2018-08-1533Review8610.3390/tropicalmed3030086http://www.mdpi.com/2414-6366/3/3/86TropicalMed, Vol. 3, Pages 85: When Should the Emphasis on Schistosomiasis Control Move to Elimination?http://www.mdpi.com/2414-6366/3/3/85
The stated goal of the World Health Organization&amp;rsquo;s program on schistosomiasis is paraphrased as follows: to control morbidity and eliminate transmission where feasible. Switching from a goal of controlling morbidity to interrupting transmission may well be currently feasible in some countries in the Caribbean, some areas in South America, northern Africa, and selected endemic areas in sub-Saharan Africa where there have been improvements in sanitation and access to clean water. However, in most of sub-Saharan Africa, where programmatic interventions still consist solely of annual mass drug administration, such a switch in strategies remains premature. There is a continued need for operational research on how best to reduce transmission to a point where interruption of transmission may be achievable. The level of infection at which it is feasible to transition from control to elimination must also be defined. In parallel, there is also a need to develop and evaluate approaches for achieving and validating elimination. There are currently neither evidence-based methods nor tools for breaking transmission or verifying that it has been accomplished. The basis for these statements stems from numerous studies that will be reviewed and summarized in this article; many, but not all of which were undertaken as part of SCORE, the Schistosomiasis Consortium for Operational Research and Evaluation.TropicalMed, Vol. 3, Pages 85: When Should the Emphasis on Schistosomiasis Control Move to Elimination?

The stated goal of the World Health Organization&amp;rsquo;s program on schistosomiasis is paraphrased as follows: to control morbidity and eliminate transmission where feasible. Switching from a goal of controlling morbidity to interrupting transmission may well be currently feasible in some countries in the Caribbean, some areas in South America, northern Africa, and selected endemic areas in sub-Saharan Africa where there have been improvements in sanitation and access to clean water. However, in most of sub-Saharan Africa, where programmatic interventions still consist solely of annual mass drug administration, such a switch in strategies remains premature. There is a continued need for operational research on how best to reduce transmission to a point where interruption of transmission may be achievable. The level of infection at which it is feasible to transition from control to elimination must also be defined. In parallel, there is also a need to develop and evaluate approaches for achieving and validating elimination. There are currently neither evidence-based methods nor tools for breaking transmission or verifying that it has been accomplished. The basis for these statements stems from numerous studies that will be reviewed and summarized in this article; many, but not all of which were undertaken as part of SCORE, the Schistosomiasis Consortium for Operational Research and Evaluation.

]]>When Should the Emphasis on Schistosomiasis Control Move to Elimination?W. Evan SecorDaniel G. Colleydoi: 10.3390/tropicalmed3030085Tropical Medicine and Infectious Disease2018-08-15Tropical Medicine and Infectious Disease2018-08-1533Review8510.3390/tropicalmed3030085http://www.mdpi.com/2414-6366/3/3/85TropicalMed, Vol. 3, Pages 84: Long-Range Diagnosis of and Support for Skin Conditions in Field Settingshttp://www.mdpi.com/2414-6366/3/3/84
Skin diseases are a significant cause of morbidity and mortality worldwide; however, access to dermatology services are critically limited, particularly in low- to middle-income countries (LMIC), where there is an overall shortage of physicians. Implementation of long-range technological support tools has been growing in an effort to provide quality dermatology care to even the most remote settings globally. eHealth strategies can provide realistic healthcare solutions if implemented in a feasible and sensitive way, customizing tools to address the unique needs and resource limitations of the local setting. This article summarizes the various types of telemedicine and mobile health (mHealth) tools and their practical applications and benefits for patient care. The challenges and barriers of teledermatology are discussed, as well as steps to consider when implementing a new teledermatology initiative. eHealth arguably offers one of the most flexible and realistic tools for providing critically needed access to dermatology skills in underserved LMICs.TropicalMed, Vol. 3, Pages 84: Long-Range Diagnosis of and Support for Skin Conditions in Field Settings

Skin diseases are a significant cause of morbidity and mortality worldwide; however, access to dermatology services are critically limited, particularly in low- to middle-income countries (LMIC), where there is an overall shortage of physicians. Implementation of long-range technological support tools has been growing in an effort to provide quality dermatology care to even the most remote settings globally. eHealth strategies can provide realistic healthcare solutions if implemented in a feasible and sensitive way, customizing tools to address the unique needs and resource limitations of the local setting. This article summarizes the various types of telemedicine and mobile health (mHealth) tools and their practical applications and benefits for patient care. The challenges and barriers of teledermatology are discussed, as well as steps to consider when implementing a new teledermatology initiative. eHealth arguably offers one of the most flexible and realistic tools for providing critically needed access to dermatology skills in underserved LMICs.

]]>Long-Range Diagnosis of and Support for Skin Conditions in Field SettingsVictoria WilliamsCarrie Kovarikdoi: 10.3390/tropicalmed3030084Tropical Medicine and Infectious Disease2018-08-13Tropical Medicine and Infectious Disease2018-08-1333Article8410.3390/tropicalmed3030084http://www.mdpi.com/2414-6366/3/3/84TropicalMed, Vol. 3, Pages 83: Risk Mapping of Visceral Leishmaniasis: A Spatial Regression Model for Attica Region, Greecehttp://www.mdpi.com/2414-6366/3/3/83
Visceral Leishmaniasis (VL) is endemic to the Attica region of Greece. The geographical distribution of VL cases was analyzed employing methods of spatial analysis in a GIS environment. A geographic database was constructed including data for the disease cases and environmental factors, such as land cover types, stray dog population, and socioeconomic factors. Classic and spatial regression models are presented that suggest the factors contributing most to the incidence of leishmaniasis are green urban areas and the population of stray dogs in the municipalities of Attica region. The results of the spatial regression model were more accurate, thus were used to produce a disease risk map. This map indicates the high-risk municipalities in which surveillance for the control of leishmaniasis is necessary.TropicalMed, Vol. 3, Pages 83: Risk Mapping of Visceral Leishmaniasis: A Spatial Regression Model for Attica Region, Greece

Visceral Leishmaniasis (VL) is endemic to the Attica region of Greece. The geographical distribution of VL cases was analyzed employing methods of spatial analysis in a GIS environment. A geographic database was constructed including data for the disease cases and environmental factors, such as land cover types, stray dog population, and socioeconomic factors. Classic and spatial regression models are presented that suggest the factors contributing most to the incidence of leishmaniasis are green urban areas and the population of stray dogs in the municipalities of Attica region. The results of the spatial regression model were more accurate, thus were used to produce a disease risk map. This map indicates the high-risk municipalities in which surveillance for the control of leishmaniasis is necessary.

]]>Risk Mapping of Visceral Leishmaniasis: A Spatial Regression Model for Attica Region, GreecePolixeni IliopoulouAndreas TsatsarisIoannis KatsiosAmalia PanagiotopoulouStelios RomaliadesByron PapadopoulosYannis Tselentisdoi: 10.3390/tropicalmed3030083Tropical Medicine and Infectious Disease2018-08-13Tropical Medicine and Infectious Disease2018-08-1333Article8310.3390/tropicalmed3030083http://www.mdpi.com/2414-6366/3/3/83TropicalMed, Vol. 3, Pages 82: Cushing Syndrome due to Inappropriate Corticosteroid Topical Treatment of Undiagnosed Scabieshttp://www.mdpi.com/2414-6366/3/3/82
The uncontrolled sale of topical corticosteroids has become an important risk factor for the development of iatrogenic Cushing syndrome in children, especially in countries where medications are sold over the counter. This is exacerbated by the lack of information for both the patients and pharmacists. This report documents a series of eight cases of iatrogenic Cushing syndrome secondary to an inappropriate use of topical steroids, due to a misdiagnosis of scabies.TropicalMed, Vol. 3, Pages 82: Cushing Syndrome due to Inappropriate Corticosteroid Topical Treatment of Undiagnosed Scabies

The uncontrolled sale of topical corticosteroids has become an important risk factor for the development of iatrogenic Cushing syndrome in children, especially in countries where medications are sold over the counter. This is exacerbated by the lack of information for both the patients and pharmacists. This report documents a series of eight cases of iatrogenic Cushing syndrome secondary to an inappropriate use of topical steroids, due to a misdiagnosis of scabies.

]]>Cushing Syndrome due to Inappropriate Corticosteroid Topical Treatment of Undiagnosed ScabiesGuadalupe Estrada-ChávezRoberto EstradaDaniel EngelmanJesus MolinaGuadalupe Chávez-Lópezdoi: 10.3390/tropicalmed3030082Tropical Medicine and Infectious Disease2018-08-03Tropical Medicine and Infectious Disease2018-08-0333Case Report8210.3390/tropicalmed3030082http://www.mdpi.com/2414-6366/3/3/82TropicalMed, Vol. 3, Pages 81: DNA Diagnostics for Schistosomiasis Controlhttp://www.mdpi.com/2414-6366/3/3/81
Despite extensive efforts over the last few decades, the global disease burden of schistosomiasis still remains unacceptably high. This could partly be attributed to the lack of accurate diagnostic tools for detecting human and animal schistosome infections in endemic areas. In low transmission and low prevalence areas where schistosomiasis elimination is targeted, case detection requires a test that is highly sensitive. Diagnostic tests with low sensitivity will miss individuals with low infection intensity and these will continue to contribute to transmission, thereby interfering with the efficacy of the control measures operating. Of the many diagnostic approaches undertaken to date, the detection of schistosome DNA using DNA amplification techniques including polymerase chain reaction (PCR) provide valuable adjuncts to more conventional microscopic and serological methods, due their accuracy, high sensitivity, and the capacity to detect early pre-patent infections. Furthermore, DNA-based methods represent important screening tools, particularly in those endemic areas with ongoing control where infection prevalence and intensity have been reduced to very low levels. Here we review the role of DNA diagnostics in the path towards the control and elimination of schistosomiasis.TropicalMed, Vol. 3, Pages 81: DNA Diagnostics for Schistosomiasis Control

Despite extensive efforts over the last few decades, the global disease burden of schistosomiasis still remains unacceptably high. This could partly be attributed to the lack of accurate diagnostic tools for detecting human and animal schistosome infections in endemic areas. In low transmission and low prevalence areas where schistosomiasis elimination is targeted, case detection requires a test that is highly sensitive. Diagnostic tests with low sensitivity will miss individuals with low infection intensity and these will continue to contribute to transmission, thereby interfering with the efficacy of the control measures operating. Of the many diagnostic approaches undertaken to date, the detection of schistosome DNA using DNA amplification techniques including polymerase chain reaction (PCR) provide valuable adjuncts to more conventional microscopic and serological methods, due their accuracy, high sensitivity, and the capacity to detect early pre-patent infections. Furthermore, DNA-based methods represent important screening tools, particularly in those endemic areas with ongoing control where infection prevalence and intensity have been reduced to very low levels. Here we review the role of DNA diagnostics in the path towards the control and elimination of schistosomiasis.

]]>DNA Diagnostics for Schistosomiasis ControlKosala G. WeerakoonCatherine A. GordonDonald P. McManusdoi: 10.3390/tropicalmed3030081Tropical Medicine and Infectious Disease2018-08-01Tropical Medicine and Infectious Disease2018-08-0133Review8110.3390/tropicalmed3030081http://www.mdpi.com/2414-6366/3/3/81TropicalMed, Vol. 3, Pages 80: New Immuno-Epidemiological Biomarker of Human Exposure to Aedes Vector Bites: From Concept to Applicationshttp://www.mdpi.com/2414-6366/3/3/80
Arthropod-borne viruses (arboviruses) such as dengue virus (DENV), chikungunya virus (CHIKV), Zika virus (ZIKV), and yellow fever virus (YFV) are the most important ‘emerging pathogens’ because of their geographic spread and their increasing impact on vulnerable human populations. To fight against these arboviruses, vector control strategies (VCS) remain one of the most valuable means. However, their implementation and monitoring are labour intensive and difficult to sustain on large scales, especially when transmission and Aedes mosquito densities are low. To increase the efficacy of VCS, current entomological methods should be improved by new complementary tools which measure the risk of arthropod-borne diseases’ transmission. The study of human–Aedes immunological relationships can provide new promising serological tools, namely antibody-based biomarkers, allowing to accurately estimate the human–Aedes contact and consequently, the risk of transmission of arboviruses and the effectiveness of VCS. This review focuses on studies highlighting the concept, techniques, and methods used to develop and validate specific candidate biomarkers of human exposure to Aedes bites. Potential applications of such antibody-based biomarkers of exposure to Aedes vector bites in the field of operational research are also discussed.TropicalMed, Vol. 3, Pages 80: New Immuno-Epidemiological Biomarker of Human Exposure to Aedes Vector Bites: From Concept to Applications

Arthropod-borne viruses (arboviruses) such as dengue virus (DENV), chikungunya virus (CHIKV), Zika virus (ZIKV), and yellow fever virus (YFV) are the most important ‘emerging pathogens’ because of their geographic spread and their increasing impact on vulnerable human populations. To fight against these arboviruses, vector control strategies (VCS) remain one of the most valuable means. However, their implementation and monitoring are labour intensive and difficult to sustain on large scales, especially when transmission and Aedes mosquito densities are low. To increase the efficacy of VCS, current entomological methods should be improved by new complementary tools which measure the risk of arthropod-borne diseases’ transmission. The study of human–Aedes immunological relationships can provide new promising serological tools, namely antibody-based biomarkers, allowing to accurately estimate the human–Aedes contact and consequently, the risk of transmission of arboviruses and the effectiveness of VCS. This review focuses on studies highlighting the concept, techniques, and methods used to develop and validate specific candidate biomarkers of human exposure to Aedes bites. Potential applications of such antibody-based biomarkers of exposure to Aedes vector bites in the field of operational research are also discussed.

]]>New Immuno-Epidemiological Biomarker of Human Exposure to Aedes Vector Bites: From Concept to ApplicationsAndré SagnaMabo YoboEmmanuel Elanga NdilleFranck Remouedoi: 10.3390/tropicalmed3030080Tropical Medicine and Infectious Disease2018-08-01Tropical Medicine and Infectious Disease2018-08-0133Review8010.3390/tropicalmed3030080http://www.mdpi.com/2414-6366/3/3/80TropicalMed, Vol. 3, Pages 79: Epidemiology and Spatiotemporal Patterns of Leprosy Detection in the State of Bahia, Brazilian Northeast Region, 2001–2014http://www.mdpi.com/2414-6366/3/3/79
The detection of leprosy cases is distributed unequally in Brazil, with high-risk clusters mainly in the North and Northeast regions. Knowledge on epidemiology and spatiotemporal patterns of leprosy occurrence and late diagnosis in these areas is critical to improve control measures. We performed a study including all leprosy cases notified in the 417 municipalities of Bahia state, from 2001 to 2014. New case detection (overall and pediatric &amp;lt;15 years) and grade 2 disability (G2D) rates were calculated and stratified according to socio-demographic variables. Spatial analyses were performed to detect high-risk areas for occurrence and late diagnosis. A total of 40,060 new leprosy cases was reported in the period (mean = 2861 cases/year), 3296 (8.2%) in &amp;lt;15-year-olds, and 1921 (4.8%) with G2D. The new case detection rate was 20.41 cases/100,000 inhabitants (95% CI: 19.68&amp;ndash;21.17). A higher risk was identified in older age groups (RR = 8.45, 95% CI: 7.08&amp;ndash;10.09) and in residents living in the state capital (RR = 5.30, 95% CI: 4.13&amp;ndash;6.79), in medium-sized cities (RR = 2.80; 95% CI: 2.50&amp;ndash;3.13), and in the west (RR = 6.56, 95% CI: 5.13&amp;ndash;8.39) and far south regions of the state (RR = 6.56, 95% CI: 5.13&amp;ndash;8.39). A higher risk of G2D was associated with male gender (RR = 2.43, 95% CI: 2.20&amp;ndash;2.67), older age (RR = 44.08, 95% CI: 33.21&amp;ndash;58.51), Afro-Brazilian ethnicity (RR = 1.59; 95% CI: 1.37&amp;ndash;1.85), living in medium-sized cities (RR = 2.60; 95% CI: 2.27&amp;ndash;2.96) and residency in the north (RR = 5.02; 95% CI: 3.74&amp;ndash;6.73) and far south (RR = 7.46; 95% CI: 5.58&amp;ndash;9.98) regions. Heterogeneous space&amp;ndash;time patterns of leprosy distribution were identified, indicating high endemicity, recent transmission, and late diagnosis. This heterogeneous distribution of the disease was observed throughout the study period. Leprosy remains a relevant public health problem in Bahia state. The disease has a focal distribution. We reinforce the importance of integrating surveillance, prevention and control actions in regions of higher risk of leprosy detection and late diagnosis, and in the most vulnerable populations.TropicalMed, Vol. 3, Pages 79: Epidemiology and Spatiotemporal Patterns of Leprosy Detection in the State of Bahia, Brazilian Northeast Region, 2001–2014

The detection of leprosy cases is distributed unequally in Brazil, with high-risk clusters mainly in the North and Northeast regions. Knowledge on epidemiology and spatiotemporal patterns of leprosy occurrence and late diagnosis in these areas is critical to improve control measures. We performed a study including all leprosy cases notified in the 417 municipalities of Bahia state, from 2001 to 2014. New case detection (overall and pediatric &amp;lt;15 years) and grade 2 disability (G2D) rates were calculated and stratified according to socio-demographic variables. Spatial analyses were performed to detect high-risk areas for occurrence and late diagnosis. A total of 40,060 new leprosy cases was reported in the period (mean = 2861 cases/year), 3296 (8.2%) in &amp;lt;15-year-olds, and 1921 (4.8%) with G2D. The new case detection rate was 20.41 cases/100,000 inhabitants (95% CI: 19.68&amp;ndash;21.17). A higher risk was identified in older age groups (RR = 8.45, 95% CI: 7.08&amp;ndash;10.09) and in residents living in the state capital (RR = 5.30, 95% CI: 4.13&amp;ndash;6.79), in medium-sized cities (RR = 2.80; 95% CI: 2.50&amp;ndash;3.13), and in the west (RR = 6.56, 95% CI: 5.13&amp;ndash;8.39) and far south regions of the state (RR = 6.56, 95% CI: 5.13&amp;ndash;8.39). A higher risk of G2D was associated with male gender (RR = 2.43, 95% CI: 2.20&amp;ndash;2.67), older age (RR = 44.08, 95% CI: 33.21&amp;ndash;58.51), Afro-Brazilian ethnicity (RR = 1.59; 95% CI: 1.37&amp;ndash;1.85), living in medium-sized cities (RR = 2.60; 95% CI: 2.27&amp;ndash;2.96) and residency in the north (RR = 5.02; 95% CI: 3.74&amp;ndash;6.73) and far south (RR = 7.46; 95% CI: 5.58&amp;ndash;9.98) regions. Heterogeneous space&amp;ndash;time patterns of leprosy distribution were identified, indicating high endemicity, recent transmission, and late diagnosis. This heterogeneous distribution of the disease was observed throughout the study period. Leprosy remains a relevant public health problem in Bahia state. The disease has a focal distribution. We reinforce the importance of integrating surveillance, prevention and control actions in regions of higher risk of leprosy detection and late diagnosis, and in the most vulnerable populations.

]]>Epidemiology and Spatiotemporal Patterns of Leprosy Detection in the State of Bahia, Brazilian Northeast Region, 2001–2014Eliana Amorim de SouzaAnderson Fuentes FerreiraJorg HeukelbachReagan Nzundu BoignyCarlos Henrique AlencarAlberto Novaes Ramosdoi: 10.3390/tropicalmed3030079Tropical Medicine and Infectious Disease2018-07-31Tropical Medicine and Infectious Disease2018-07-3133Article7910.3390/tropicalmed3030079http://www.mdpi.com/2414-6366/3/3/79TropicalMed, Vol. 3, Pages 78: Differential Susceptibility of Male Versus Female Laboratory Mice to Anaplasma phagocytophilum Infectionhttp://www.mdpi.com/2414-6366/3/3/78
Human granulocytic anaplasmosis (HGA) is a debilitating, non-specific febrile illness caused by the granulocytotropic obligate intracellular bacterium called Anaplasma phagocytophilum. Surveillance studies indicate a higher prevalence of HGA in male versus female patients. Whether this discrepancy correlates with differential susceptibility of males and females to A. phagocytophilum infection is unknown. Laboratory mice have long been used to study granulocytic anaplasmosis. Yet, sex as a biological variable (SABV) in this model has not been evaluated. In this paper, groups of male and female C57Bl/6 mice that had been infected with A. phagocytophilum were assessed for the bacterial DNA load in the peripheral blood, the percentage of neutrophils harboring bacterial inclusions called morulae, and splenomegaly. Infected male mice exhibited as much as a 1.85-fold increase in the number of infected neutrophils, which is up to a 1.88-fold increase in the A. phagocytophilum DNA load, and a significant increase in spleen size when compared to infected female mice. The propensity of male mice to develop a higher level of A. phagocytophilum infection is relevant for studies utilizing the mouse model. This stresses the importance of including SABV and aligns with the observed higher incidence of infection in male versus female patients.TropicalMed, Vol. 3, Pages 78: Differential Susceptibility of Male Versus Female Laboratory Mice to Anaplasma phagocytophilum Infection

Human granulocytic anaplasmosis (HGA) is a debilitating, non-specific febrile illness caused by the granulocytotropic obligate intracellular bacterium called Anaplasma phagocytophilum. Surveillance studies indicate a higher prevalence of HGA in male versus female patients. Whether this discrepancy correlates with differential susceptibility of males and females to A. phagocytophilum infection is unknown. Laboratory mice have long been used to study granulocytic anaplasmosis. Yet, sex as a biological variable (SABV) in this model has not been evaluated. In this paper, groups of male and female C57Bl/6 mice that had been infected with A. phagocytophilum were assessed for the bacterial DNA load in the peripheral blood, the percentage of neutrophils harboring bacterial inclusions called morulae, and splenomegaly. Infected male mice exhibited as much as a 1.85-fold increase in the number of infected neutrophils, which is up to a 1.88-fold increase in the A. phagocytophilum DNA load, and a significant increase in spleen size when compared to infected female mice. The propensity of male mice to develop a higher level of A. phagocytophilum infection is relevant for studies utilizing the mouse model. This stresses the importance of including SABV and aligns with the observed higher incidence of infection in male versus female patients.

]]>Differential Susceptibility of Male Versus Female Laboratory Mice to Anaplasma phagocytophilum InfectionWaheeda A. NaimiRyan S. GreenChelsea L. CockburnJason A. Carlyondoi: 10.3390/tropicalmed3030078Tropical Medicine and Infectious Disease2018-07-23Tropical Medicine and Infectious Disease2018-07-2333Article7810.3390/tropicalmed3030078http://www.mdpi.com/2414-6366/3/3/78TropicalMed, Vol. 3, Pages 77: Day Biting Habits of Mosquitoes Associated with Mangrove Forests in Kedah, Malaysiahttp://www.mdpi.com/2414-6366/3/3/77
Due to conservation and rehabilitation efforts, mangrove forests represent some of the largest environmental niches in Malaysia. However, there is little information on the potential risks posed by mosquitoes that are directly and indirectly associated with mangrove forests. To study the potential health risk to humans active within and in close vicinity of mangrove forests, this research focused on the day biting habits of mosquitoes in mangrove forests of Kedah, Malaysia. The bare leg catch (BLC) method was used to collect adult mosquitoes during a 12-h period from 7:30 a.m. to 7:30 p.m. in both disturbed and less disturbed areas of mangroves. In total, 795 adult mosquitoes from 5 genera and 8 species were collected, and over 65% of the total mosquitoes were collected from the less disturbed area. The predominant species from the less disturbed area was Verrallina butleri; in the disturbed area the dominant species was Culex sitiens. The peak biting hour differed for each species, with Aedes albopictus and Cx. sitiens recorded as having a bimodal biting activity peak during dawn and dusk. For Ve. butleri an erratic pattern of biting activity was recorded in the less disturbed area but it peaked during the early daytime for both collection points. Overall, the distinct pattern of day biting habits of mosquitoes within mangroves peaked during dawn and dusk for the less disturbed area but was irregular for the disturbed area throughout the day. The presence of vectors of pathogens such as Ae. albopictus for both areas raises the need for authorities to consider management of mosquitoes in mangrove forests.TropicalMed, Vol. 3, Pages 77: Day Biting Habits of Mosquitoes Associated with Mangrove Forests in Kedah, Malaysia

Due to conservation and rehabilitation efforts, mangrove forests represent some of the largest environmental niches in Malaysia. However, there is little information on the potential risks posed by mosquitoes that are directly and indirectly associated with mangrove forests. To study the potential health risk to humans active within and in close vicinity of mangrove forests, this research focused on the day biting habits of mosquitoes in mangrove forests of Kedah, Malaysia. The bare leg catch (BLC) method was used to collect adult mosquitoes during a 12-h period from 7:30 a.m. to 7:30 p.m. in both disturbed and less disturbed areas of mangroves. In total, 795 adult mosquitoes from 5 genera and 8 species were collected, and over 65% of the total mosquitoes were collected from the less disturbed area. The predominant species from the less disturbed area was Verrallina butleri; in the disturbed area the dominant species was Culex sitiens. The peak biting hour differed for each species, with Aedes albopictus and Cx. sitiens recorded as having a bimodal biting activity peak during dawn and dusk. For Ve. butleri an erratic pattern of biting activity was recorded in the less disturbed area but it peaked during the early daytime for both collection points. Overall, the distinct pattern of day biting habits of mosquitoes within mangroves peaked during dawn and dusk for the less disturbed area but was irregular for the disturbed area throughout the day. The presence of vectors of pathogens such as Ae. albopictus for both areas raises the need for authorities to consider management of mosquitoes in mangrove forests.